Research and analysis

Acquired carbapenemase-producing Gram-negative bacteria in England: October 2020 to September 2023

Updated 17 April 2024

Applies to England

Background

Since 1 October 2020, all diagnostic laboratories in England have a duty to notify the following via the UK Health Security Agency (UKHSA)’s Second Generation Surveillance System (SGSS) (1):

• acquired carbapenemase-producing Gram-negative bacteria identified in human samples
• the results of any antimicrobial susceptibility test and carbapenem resistance mechanism in any of the causative agents listed in Schedule 2 of the Health Protection (Notification) Regulations 2020 (1).

This requirement was launched in conjunction with the national Framework of actions to contain carbapenemase-producing Enterobacterales (CPE), which sets out a range of measures that, if implemented well, will help health and social care providers minimise the impact of CPE.

The analyses below are based on data relating to notifications of confirmed acquired carbapenemase-producing Gram-negative bacteria between 1 October 2020 and 30 September 2023 in England. The data was extracted on 16 November 2023 from both UKHSA’s voluntary surveillance database, SGSS, and the Antimicrobial Resistance and Healthcare-Associated Infections (AMRHAI) Reference Unit database.

Rates of acquired carbapenemase-producing Gram-negative bacteria were calculated using mid-year resident population estimates for the respective year and geography. Geographical analyses were based on the patient’s residential postcode. Where this information was unknown, the postcode of the patient’s GP was used. Failing that, the postcode of the reporting laboratory was used. Cases in England were further assigned to one of 9 local areas, formed from the administrative local authority boundaries.

As patients may have more than one positive specimen taken, specimens taken from the same patient that yielded growth of the same pathogen and carbapenemase within a 52-week period from the initial positive sterile site specimen, screening site specimen or other specimen type (grouped together), were regarded as comprising the same episode and were de-duplicated. Carbapenemase-producing Gram-negative bacteria referred isolates and local laboratory isolates were combined for this de-duplication process, with resistance mechanism results from the AMRHAI Reference Unit retained preferentially where patient specimen overlap occurred. This method differs slightly from the weekly causative agent notification data, where data is not de-duplicated incorporating specimen type. In addition, the data presented in the weekly notification reports utilises SGSS reports only.

The following report summarises trends and geographical distribution of carbapenemase mechanisms identified from Gram-negative bacteria in human samples. Species, mechanism, sample type, and age and sex of patients are also described. For the purposes of this report, quarters are calendar quarters, as such January to March is referred to as ‘Q1’, April to June is referred to as ‘Q2’, July to September is referred to as ‘Q3’ and October to December is referred to as ‘Q4’, alongside relevant years.

Please note, scientific names are not italicised in this report to ensure our content is inclusive for all users and in compliance with web accessibility legislation and associated guidelines.

Microbiology services

For reference services, including species identification and confirmation of susceptibility testing results, laboratories should contact UKHSA’s AMRHAI Reference Unit in Colindale, London.

Table 1 summarises the carbapenemase gene families that are targeted – using the routine polymerase chain reaction (PCR) applied to referred Enterobacterales, Pseudomonas spp. and Acinetobacter spp. – because they are suspected of harbouring an acquired carbapenemase gene. UKHSA strongly recommends that all diagnostic laboratories are able to detect, at least, the 4 carbapenemase families shown in bold in this table (the ‘big 4’) using either PCR or immunochromatographic methods.

Where an ‘exceptional’ carbapenemase and species combination result (cells without a ¥ symbol in Table 1) has been identified, or where an unusual organism has been identified with an acquired carbapenemase (that is, any bacterial genera other than a member of the Enterobacterales, Pseudomonas spp. or Acinetobacter spp.), isolates should be sent to the AMRHAI Reference Unit for confirmation.

Table 1. Distribution of carbapenemase genes covered by AMRHAI Reference Unit molecular assay (based on AMRHAI data) [note 1]

Carbapenemase family	Associated with common ‘host’ organism Enterobacterales	Associated common ‘host’ organism Pseudomonas spp.	Associated with common ‘host’ organism Acinetobacter spp.
KPC	¥	<10D	<10D
OXA-48-like	¥	<10D	0
NDM	¥	¥	¥
VIM	¥	¥	<10D
IMP	¥	¥	¥
IMI/NMC-A	¥B	0	0
GES	¥	¥	<10D
FRI	<10	0	0
SME	¥C	0	0
DIM	0	<10D	0
GIM	<10D	<10D	0
SIM	0	<10D	0
SPM	0	<10D	0
OXA-23-like	<10D	0	¥
OXA-40-like	0	0	¥
OXA-51-likeA	0	0	¥
OXA-58-like	0	0	¥

View this table in the data tables file

Notes to Table 1

Note 1. Table 1 uses the following symbols:

¥ = combinations of mechanism and species would not be considered as exceptional results.

A = intrinsic to A. baumannii and only expressed when associated with an insertion element.

B = almost exclusively reported in Enterobacter spp. with less than a handful of reports in other genera.

C = reported only in Serratia marcescens.

D = fewer than 10 in total ever referred to AMRHAI Reference Unit.

Recent developments

Unusual acquired carbapenemase-producing Gram-negative bacteria referred to the AMRHAI Reference Unit in Q3 2023 consisted of 6 GIM-producers (4 Pseudomonas aeruginosa and 2 Citrobacter freundii) associated with an outbreak in the West Midlands; the P. aeruginosa isolates were isolated from 3 patients with invasive infections whereas the C. freundii represented gut colonisation of a further patient. In addition, 8 IMI-producing Enterobacter spp. were referred from six patients in six regions; all represented gut colonisations.

Samples from unusual combinations of organism and mechanism should be referred to the AMRHAI Reference Unit for confirmation. Follow-up of such unusual drug/bug combinations has shown that some were due to mixed cultures or reporting errors.

Specimen type

Between October 2020 and September 2023, there were 10,584 acquired carbapenemase-producing Gram-negative bacteria episodes. The majority were identified in screening samples, accounting for 71.0% of carbapenemase notifications, with only 4.7% reported in sterile site specimens (Table 2).

Table 2. Number and percentage of acquired carbapenemase-producing Gram-negative bacterial episodes by specimen type (England): October 2020 to September 2023

Specimen type	All reports number	All reports % [note 3]	From AMRHAI number	From AMRHAI % [note 4]
Sterile site samples	496	4.7	184	10.3
Screening samples	7,514	71.0	853	47.7
Other samples [note 3]	2,574	24.3	752	42.0
All samples	10,584	100.0	1,789	100.0

View this table in the data tables file

Notes to Table 2

Note 2. Samples that do not fall into either ‘sterile site’ or ‘screening’ samples, for example, urine and lower respiratory tract specimens.

Note 3. The percentages presented in this table are column percentages, with the breakdown of specimen types shown for all reports and AMRHAI reports separately.

Note 4. The AMRHAI Reference Unit actively encourages submission of sterile site isolates for carbapenemase confirmation; the distribution of specimen type will reflect this.

Quarterly trends

The quarterly rate of acquired carbapenemase-producing Gram-negative bacterial episodes between October 2020 and September 2023 is shown in Figure 1.

Although, in this quarter, the rate of carbapenemase-producing Gram-negative bacterial episodes continued to increase – from 2.1 per 100,000 population in Q2 2023 to 2.7 per 100,000 population in Q3 2023 – this rise was predominantly due to increases among screening samples, with the number of sterile site isolates remaining relatively stable (Figure 1). Most of this increase appears to correlate with increased detection relating to screening following localised hospital outbreaks.

It is important to note that quarterly changes in rate of episodes may reflect an uptick in screening following changes to screening policy rather than an actual increase in incidence. Furthermore, as there are only 12 quarters of notification data, it is too early to conclude that there may be any seasonality, particularly in light of the COVID-19 pandemic, where quarterly changes may be affected by COVID-19 ‘waves’ seen during this period or associated with local carbapenemase-producing Gram-negative bacteria outbreaks.

The remaining data summaries in this report consider all samples grouped together.

Figure 1. Rate of acquired carbapenemase-producing Gram-negative bacteria episodes by specimen type and quarter (England): October 2020 to September 2023

Geographic distribution

The rate of acquired carbapenemase-producing Gram-negative bacterial episodes varied by Office for National Statistics (ONS) region (Figure 2), with the highest overall rate between October 2022 and September 2023 reported in the North West (2.1 episodes per 100,000 population), followed by the London region (1.9 episodes per 100,000 population). The lowest incidence across the last year was reported in the South West region (0.2 per 100,000 population).

Figure 2. Geographical distribution of acquired carbapenemase-producing Gram negative bacterial incidence rates per 100,000 population (England): October 2022 to September 2023 [note 5]

Note to Figure 2

Note 5. The region geography is based on the laboratory location and linked to the ONS data for regions.

The rate of acquired carbapenemase-producing Gram-negative bacterial episodes for each ONS region by calendar quarter is shown in Table 3.

The rate of bacterial episodes in all ONS regions increased from Q2 2023 to Q3 2023 in all regions except East Midlands and the South East, where the rate remained stable. A large increase was noted in the North East, where the rate increased from 1.2 to 3.7 per 100,000 population. The increase in the North East was mostly seen in screening samples and was noted in one lab in particular.

Table 3. Rate per 100,000 population of acquired carbapenemase-producing Gram-negative bacterial episodes by ONS region (England): October 2022 to September 2023

ONS region	Q4 2022 number	Q4 2022 rate	Q1 2023 number	Q1 2023 rate	Q2 2023 number	Q2 2023 rate	Q3 2023 number	Q3 2023 rate
East Midlands	66	1.4	48	1.0	46	0.9	46	0.9
East of England	31	0.5	25	0.4	33	0.5	55	0.9
London	285	3.2	389	4.4	391	4.4	473	5.4
North East	35	1.3	54	2.0	33	1.2	98	3.7
North West	347	4.7	309	4.2	349	4.7	403	5.4
South East	64	0.7	60	0.6	69	0.7	68	0.7
South West	21	0.4	16	0.3	17	0.3	34	0.6
West Midlands	169	2.8	132	2.2	200	3.4	251	4.2
Yorkshire and The Humber	92	1.7	74	1.4	74	1.4	93	1.7

View this table in the data tables file

Geographical differences in carbapenemase family

Between October 2022 and September 2023, the most common carbapenemase families reported across all regions were NDM (34.5%), OXA-48-like (33.6%) and KPC (24.0%). However, similarly to the incidence of episodes, the distribution of carbapenemase families identified also varied regionally (Figure 3).

In the North West, which had the highest incidence rate, the most common carbapenemase families identified were KPC (50.4%) and OXA-48-like (25.6%). KPC was not as common in any of the other regions, accounting for fewer than 32.0% of episodes in each region. For example, in London, which also had a high overall incidence rate, KPC accounted for 4.2% of episodes with NDM and OXA-48-like carbapenemases dominating (48.8% and 37.6%, respectively).

Another regional difference was observed in the North East and in Yorkshire and The Humber, where IMP was more common compared to any of the other regions, accounting for 15.0% and 11.7% of episodes, respectively (other regions reporting fewer than 9.1%). However, given the small number of carbapenemases reported in some regions, the diversity of carbapenemases reported is likely to be strongly impacted by individual outbreaks. In the two regions that had the lowest incidence rates, the most common carbapenemase family was OXA-48-like (59.0% in the East of England and 38.6% in the South West, respectively).

The distribution of carbapenemase families within each ONS region also varied by quarter. For example, the most common carbapenemase family identified in the East Midlands was predominantly NDM in Q3 2023 (67.4%) whereas in Q4 2022 it had been predominantly OXA-48-like (60.6%); however, for both quarters the majority were identified in screening samples (77.4% and 72.7%, respectively).

Figure 3. Geographical distribution of acquired carbapenemase-producing Gram-negative bacterial episodes by carbapenemase family (England): October 2022 to September 2023

Note to Figure 3

Note 6. Other carbapenemase families include DIM, GES, GIM, IMI, OXA-23 (in genera other than Acinetobacter spp.) and SME.

Distribution of species and carbapenemase family

Between October 2022 and September 2023, the most frequently isolated Gram-negative bacterial species with a confirmed acquired carbapenemase was Escherichia coli, accounting for 33.9% of all specimens. This was followed by Klebsiella pneumoniae, and Enterobacter spp., which accounted for 32.4% and 17.4% of all specimens, respectively (Table 4).

The carbapenemase family most frequently identified in E. coli and Enterobacter spp. isolates was NDM (41.3% and 39.5%, respectively), and in K. pneumoniae isolates was OXO-48-like (35.3%). In E. coli and Enterobacter spp. isolates, this was followed by OXA-48-like and KPC carbapenemase families (40.4% and 16.0% in E. coli, and 20.0% and 23.6% for Enterobacter spp., respectively), and in K. pneumoniae isolates this was followed by KPC and NDM carbapenemase families (31.6% and 29.0%, respectively).

Aside from the ‘big 5’ carbapenemase families (KPC, OXA-48-like, NDM, VIM and IMP), the AMRHAI Reference Unit also screens for rarer carbapenemase families and it is recommended that all isolates suspected of producing a carbapenemase, but negative for the ‘big 5’ carbapenemase families, are referred to the AMRHAI Reference Unit for further screening. Between October 2020 and September 2023, DIM, GES, GIM, IMI, OXA-23 and SME carbapenemases were identified in small numbers (1, 28, 8, 31, 6 and 2, respectively) with only 5 isolates (GIM positive) being identified from an invasive specimen.

Table 4. Acquired carbapenemase-producing Gram-negative bacterial episodes by species and carbapenemase family (England): October 2022 to September 2023

Species	IMP number (%)	KPC number (%)	NDM number (%)	OXA-48-like number (%)	VIM number (%)	Other number (%)	Total number	% of Total per species
Acinetobacter spp. [note 7]	5 (10)	2 (4)	39 (77)	3 (6)	2 (4)	0 (0)	51	1
Citrobacter spp.	11 (5)	63 (26)	47 (19)	112 (46)	9 (4)	1 (<1)	243	5
Enterobacter spp.	106 (12)	203 (24)	340 (40)	172 (20)	29 (3)	11 (1)	861	17
Escherichia coli	22 (1)	269 (16)	694 (41)	678 (40)	17 (1)	0 (0)	1,680	34
Other Escherichia spp.	0 (0)	9 (64)	3 (21)	2 (14)	0 (0)	0 (0)	14	<1
Klebsiella oxytoca	3 (2)	72 (56)	16 (12)	35 (27)	3 (2)	0 (0)	129	3
Klebsiella pneumoniae	32 (2)	508 (32)	466 (29)	568 (35)	32 (2)	1 (<1)	1,607	32
Other Klebsiella spp.	2 (3)	21 (28)	17 (22)	33 (43)	3 (4)	0 (0)	76	2
Morganella spp.	0 (0)	1 (7)	4 (29)	8 (57)	1 (7)	0 (0)	14	<1
Pseudomonas aeruginosa [note 7]	21 (16)	6 (5)	46 (35)	7 (5)	42 (32)	10 (8)	132	3
Other Pseudomonas spp. [note 7]	2 (8)	1 (4)	8 (33)	0 (0)	12 (50)	1 (4)	24	<1
Serratia spp.	0 (0)	1 (5)	6 (27)	12 (55)	1 (5)	2 (9)	22	<1
Other Enterobacterales [note 8]	2 (2)	33 (34)	24 (25)	32 (33)	3 (3)	2 (2)	96	2
Other Gram-negative bacteria [note 9]	1 (25)	1 (25)	2 (50)	0 (0)	0 (0)	0 (0)	4	<1
Total	207 (4)	1,190 (24)	1,712 (35)	1,662 (34)	154 (3)	28 (1)	4,953	100

View this table in the data tables file

Notes to Table 4

Note 7. KPC and OXA-48-like in Pseudomonas spp. and OXA-48-like in Acinetobacter spp. are extremely rare, and results should be interpreted with caution. The numbers reported here have not been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should be referring such isolates to AMRHAI.

Note 8. Includes coliform, Cronobacter spp., Hafnia spp., Kluyvera spp., Leclercia adecarboxylata, Lelliottia amnigena, Mixta calida, Pantoea spp., Phytobacter ursingii, Pluralibacter gergoviae, Proteus spp., Providencia spp., Raoultella spp., and Shigella spp.

Note 9. The numbers reported here have not all been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should be referring such isolates to AMRHAI.

Age and sex distribution

Between October 2022 and September 2023, the rate of acquired carbapenemase-producing Gram-negative bacterial episodes was highest among the oldest and youngest members of the population. A similar age pattern was noted for both sexes, although overall the rate was higher in males compared to females (overall rates of 9.9 and 7.5 episodes per 100,000 population, respectively: Figure 4). This aligns with the age group and sex distribution noted in previously published reports on Gram-negative bacteraemia such as E. coli, Klebsiella spp., P. aeruginosa and Enterobacter spp.

Figure 4. Rate [note 10] of acquired carbapenemase-producing Gram-negative bacterial episodes per 100,000 population by age and sex [note 11] (England): October 2022 to September 2023

Notes to Figure 4

Note 10. Rates have been calculated using cumulative reports across the last 4 quarters of reporting and, as such, cannot be compared to previous quarters (2).

Note 11. Information about patient sex is only recorded in 99.1% of cases.

Figure 4 shows the acquired carbapenemase-producing Gram-negative bacterial incidence rates by age group between October 2022 to September 2023, with the highest rate reported in those 85 years and over (50.2 per 100,000 population) followed by those aged 75 to 84 years (30.6 per 100,000 population). The overall rate of confirmed carbapenemases was 10.5 per 100,000 population in infants less than 1 year old.

Quarterly mandatory laboratory return reporting (October 2022 to September 2023)

Table 5. Quarterly mandatory laboratory returns (QMLR) for the total number of rectal swabs and faecal screening specimens taken for CPE screening by acute trust type [note 12] (England): October 2022 to September 2023

Trust type [note 12]	Q4 2022 Trusts reporting (%)	Q4 2022 Total screens	Q1 2023 Trusts reporting (%)	Q1 2023 Total screens	Q2 2023 Trusts reporting (%)	Q2 2023 Total screens	Q3 2023 Trusts reporting (%)	Q3 2023 Total screens
Small (n=22)	15 (68)	4,596	14 (64)	6,813	14 (64)	6,119	12 (55)	6,727
Medium (n=21)	19 (91)	5,291	19 (91)	6,554	18 (86)	6,216	15 (71)	7,007
Large (n=24)	21 (88)	14,040	19 (79)	11,980	19 (79)	14,010	17 (71)	18,143
Multi-service (n=7)	7 (100)	1,887	7 (100)	2,219	7 (100)	3,079	6 (86)	6,005
Specialist (n=16)	10 (63)	4,220	9 (56)	3,845	10 (63)	4,239	9 (56)	3,961
Teaching (n=47)	40 (85)	84,028	36 (77)	67,582	34 (72)	69,465	34 (72)	74,593
Total	112 (82)	114,062	104 (76)	98,993	102 (75)	103,128	93 (68)	116,436

View this table in the data tables file

Note to Table 5

Note 12. Trust type obtained through NHS Digital Estate Return Information Collection (ERIC).

Reporting of quarterly totals of rectal swabs and faecal specimens taken for CPE screening was added to the mandatory QMLR section of the HCAI DCS in October 2019, and reporting became mandatory in October 2020. Between October 2022 and September 2023, there were 432,619 screens reported by 114 NHS trusts leading to an overall trust reporting rate of 83.2% (Table 5). This means that, across the four quarters, there were 137 instances where an NHS trust did not submit a return. Of the acute trusts that reported screening data, 4.4% reported that they conducted zero screens.

Between October 2022 and September 2023, the number of trusts that reported screens declined from 81.8% to 67.9%. Screening was more predominant in the acute teaching trusts, accounting for 68.3% of screening swabs taken during this time period. By reporting acute trust, the total screens reported for the quarter ranged from 0 to 19,472. The full list of reporting, including those that did not submit a return, is available in the data appendix associated with this report, by individual NHS acute trust.

References

1. Department of Health and Social Care (2020). The Health Protection (Notification) (Amendment) (No.2) Regulations 2020/674.

2. UKHSA (2023). Quarterly laboratory surveillance of acquired carbapenemase-producing Gram-negative bacteria in England: October 2020 to December 2022.

Appendix

Appendix Table 1. QMLR returns for the total number of rectal swabs and faecal screening specimens taken for CPE screening by acute trust (England): October 2022 to September 2023

Trust name	Trust type	Q4 2022	Q1 2023	Q2 2023	Q3 2023
Airedale NHS Foundation Trust	Small	125	2161	327	381
Alder Hey Children’s NHS Foundation Trust	Specialist	1,193	1,210	1,256	1,178
Ashford and St Peter’s Hospitals NHS Foundation Trust	Medium	461	257	228	223
Barking, Havering and Redbridge University Hospitals NHS Trust	Teaching	1,158	1,171	1,322	1,402
Barnsley Hospital NHS Foundation Trust	Small	30	43	228	229
Barts Health NHS Trust	Teaching	3,252	3,143	3,706	4,032
Bedfordshire Hospitals NHS Foundation Trust	Medium	161	109	112	Not reported
Birmingham Women’s and Children’s NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
Blackpool Teaching Hospitals NHS Foundation Trust	Teaching	853	753	853	844
Bolton NHS Foundation Trust	Medium	339	358	697	547
Bradford Teaching Hospitals NHS Foundation Trust	Teaching	2,311	2,161	2,403	2,355
Buckinghamshire Healthcare NHS Trust	Multi-service	407	315	473	549
Calderdale and Huddersfield NHS Foundation Trust	Large	225	272	482	517
Cambridge University Hospitals NHS Foundation Trust	Teaching	1,815	1,719	1,876	2,086
Chelsea and Westminster Hospital NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	Not reported
Chesterfield Royal Hospital NHS Foundation Trust	Small	Not reported	Not reported	Not reported	Not reported
Countess of Chester Hospital NHS Foundation Trust	Small	Not reported	Not reported	Not reported	Not reported
County Durham and Darlington NHS Foundation Trust	Multi-service	162	161	917	1,905
Croydon Health Services NHS Trust	Medium	272	493	119	199
Dartford and Gravesham NHS Trust	Small	217	263	230	263
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust	Teaching	193	222	304	895
Dorset County Hospital NHS Foundation Trust	Small	3	92	184	Not reported
East and North Hertfordshire NHS Trust	Large	1,530	1,144	1,252	1,439
East Cheshire NHS Trust	Small	Not reported	Not reported	Not reported	Not reported
East Kent Hospitals University NHS Foundation Trust	Teaching	312	328	462	526
East Lancashire Hospitals NHS Trust	Large	549	351	509	452
East Suffolk and North Essex NHS Foundation Trust	Large	Not reported	Not reported	Not reported	Not reported
East Sussex Healthcare NHS Trust	Large	299	299	238	25
Epsom and St Helier University Hospitals NHS Trust	Teaching	246	277	265	293
Frimley Health NHS Foundation Trust	Large	757	679	793	2,221
Gateshead Health NHS Foundation Trust	Medium	15	55	Not reported	Not reported
George Eliot Hospital NHS Trust	Small	254	Not reported	213	224
Gloucestershire Hospitals NHS Foundation Trust	Large	100	129	131	Not reported
Great Ormond Street Hospital For Children NHS Foundation Trust	Specialist	1,577	1,747	1,715	1,692
Great Western Hospitals NHS Foundation Trust	Medium	151	147	186	Not reported
Guy’s and St Thomas’ NHS Foundation Trust	Teaching	492	Not reported	Not reported	Not reported
Hampshire Hospitals NHS Foundation Trust	Large	333	380	258	779
Harrogate and District NHS Foundation Trust	Small	84	109	101	100
Homerton Healthcare NHS Foundation Trust	Teaching	844	854	892	939
Hull University Teaching Hospitals NHS Trust	Teaching	209	211	219	1,002
Imperial College Healthcare NHS Trust	Teaching	19,472	18,424	17,909	19,078
Isle of Wight NHS Trust	Multi-service	52	35	44	53
James Paget University Hospitals NHS Foundation Trust	Teaching	33	Not reported	Not reported	Not reported
Kettering General Hospital NHS Foundation Trust	Small	259	238	316	287
King’s College Hospital NHS Foundation Trust	Teaching	9,679	Not reported	Not reported	Not reported
Kingston Hospital NHS Foundation Trust	Medium	88	100	257	216
Lancashire Teaching Hospitals NHS Foundation Trust	Teaching	591	596	826	822
Leeds Teaching Hospitals NHS Trust	Teaching	1,572	829	785	1,540
Lewisham and Greenwich NHS Trust	Large	1,572	829	785	1,540
Liverpool Heart and Chest Hospital NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
Liverpool University Hospitals NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	Not reported
Liverpool Women’s NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
London North West University Healthcare NHS Trust	Teaching	1,040	734	1,863	Not reported
Maidstone and Tunbridge Wells NHS Trust	Large	297	293	311	346
Manchester University NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	Not reported
Medway NHS Foundation Trust	Medium	Not reported	Not reported	Not reported	Not reported
Mid and South Essex NHS Foundation Trust	Large	Not reported	Not reported	Not reported	Not reported
Mid Cheshire Hospitals NHS Foundation Trust	Small	Not reported	Not reported	Not reported	Not reported
Mid Yorkshire Hospitals NHS Trust	Large	137	95	136	Not reported
Milton Keynes University Hospital NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	Not reported
Moorfields Eye Hospital NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
Norfolk and Norwich University Hospitals NHS Foundation Trust	Teaching	604	524	523	446
North Bristol NHS Trust	Large	85	Not reported	Not reported	Not reported
North Cumbria Integrated Care NHS Foundation Trust	Small	1,057	1,030	1,163	600
North Middlesex University Hospital NHS Trust	Teaching	Not reported	Not reported	Not reported	Not reported
North Tees and Hartlepool NHS Foundation Trust	Medium	285	284	290	Not reported
North West Anglia NHS Foundation Trust	Large	797	829	662	665
Northampton General Hospital NHS Trust	Medium	797	829	662	665
Northern Care Alliance NHS Foundation Trust	Teaching	859	804	894	603
Northern Lincolnshire and Goole NHS Foundation Trust	Medium	31	52	184	368
Northumbria Healthcare NHS Foundation Trust	Large	218	185	225	235
Nottingham University Hospitals NHS Trust	Teaching	1,527	1,732	1,696	2,136
Oxford University Hospitals NHS Foundation Trust	Teaching	1,824	1,781	2,002	2,108
Portsmouth Hospitals University National Health Service Trust	Large	268	246	264	26
Queen Victoria Hospital NHS Foundation Trust	Specialist	Not reported	Not reported	6	Not reported
Royal Berkshire NHS Foundation Trust	Large	1,994	1,497	2,514	2,474
Royal Cornwall Hospitals NHS Trust	Large	174	202	224	201
Royal Devon University Healthcare NHS Foundation Trust	Large	258	192	330	448
Royal Free London NHS Foundation Trust	Teaching	8,365	8,340	8,311	8,298
Royal National Orthopaedic Hospital NHS Trust	Specialist	255	189	201	203
Royal Papworth Hospital NHS Foundation Trust	Specialist	75	99	44	78
Royal Surrey County Hospital NHS Foundation Trust	Medium	1,162	1,209	1,249	1,356
Royal United Hospitals Bath NHS Foundation Trust	Medium	160	303	548	558
Salisbury NHS Foundation Trust	Small	113	144	188	Not reported
Sandwell and West Birmingham Hospitals NHS Trust	Large	Not reported	Not reported	Not reported	Not reported
Sheffield Children’s NHS Foundation Trust	Specialist	54	111	86	57
Sheffield Teaching Hospitals NHS Foundation Trust	Teaching	1,135	1,127	1,138	1,499
Sherwood Forest Hospitals NHS Foundation Trust	Medium	Not reported	Not reported	Not reported	Not reported
Somerset NHS Foundation Trust	Multi-service	853	854	1,450	2,967
South Tees Hospitals NHS Foundation Trust	Teaching	260	288	466	501
South Tyneside and Sunderland NHS Foundation Trust	Large	Not reported	Not reported	Not reported	Not reported
South Warwickshire University NHS Foundation Trust	Medium	405	533	638	903
Southport and Ormskirk Hospital NHS Trust	Small	Not reported	Not reported	Not reported	Not reported
St George’s University Hospitals NHS Foundation Trust	Teaching	1,476	988	1,176	1,096
St Helens and Knowsley Teaching Hospitals NHS Trust	Teaching	1,491	1,274	1,634	1,612
Stockport NHS Foundation Trust	Medium	420	388	427	397
Surrey and Sussex Healthcare NHS Trust	Medium	177	252	265	233
Tameside and Glossop Integrated Care NHS Foundation Trust	Small	182	192	Not reported	Not reported
The Christie NHS Foundation Trust	Specialist	Not reported	Not reported	393	382
The Clatterbridge Cancer Centre NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
The Dudley Group NHS Foundation Trust	Medium	24	40	39	30
The Hillingdon Hospitals NHS Foundation Trust	Small	Not reported	Not reported	Not reported	Not reported
The Newcastle Upon Tyne Hospitals NHS Foundation Trust	Teaching	539	670	1,001	922
The Princess Alexandra Hospital NHS Trust	Small	250	232	254	204
The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust	Small	211	219	203	161
The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust	Specialist	27	104	126	42
The Rotherham NHS Foundation Trust	Small	1	16	26	Not reported
The Royal Marsden NHS Foundation Trust	Specialist	691	Not reported	Not reported	Not reported
The Royal Orthopaedic Hospital NHS Foundation Trust	Specialist	348	385	412	329
The Royal Wolverhampton NHS Trust	Large	2,401	2,219	2,525	2,777
The Shrewsbury and Telford Hospital NHS Trust	Medium	116	114	104	152
The Walton Centre NHS Foundation Trust	Specialist	Not reported	Not reported	Not reported	Not reported
Torbay and South Devon NHS Foundation Trust	Multi-service	8	1	8	12
United Lincolnshire Hospitals NHS Trust	Large	597	743	627	943
University College London Hospitals NHS Foundation Trust	Teaching	902	957	950	977
University Hospital Southampton NHS Foundation Trust	Teaching	574	647	1,290	771
University Hospitals Birmingham NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	Not reported
University Hospitals Bristol and Weston NHS Foundation Trust	Teaching	Not reported	Not reported	Not reported	687
University Hospitals Coventry and Warwickshire NHS Trust	Teaching	Not reported	Not reported	Not reported	687
University Hospitals Dorset NHS Foundation Trust	Teaching	127	204	232	Not reported
University Hospitals of Derby and Burton NHS Foundation Trust	Teaching	243	222	227	222
University Hospitals of Leicester NHS Trust	Teaching	8,011	8,018	7,911	8,819
University Hospitals of Morecambe Bay NHS Foundation Trust	Teaching	127	204	232	Not reported
University Hospitals of North Midlands NHS Trust	Teaching	8,988	Not reported	Not reported	Not reported
University Hospitals Plymouth NHS Trust	Teaching	808	919	888	997
University Hospitals Sussex NHS Foundation Trust	Teaching	487	526	483	487
Walsall Healthcare NHS Trust	Small	873	991	1,513	2,030
Warrington and Halton Teaching Hospitals NHS Foundation Trust	Teaching	290	272	388	376
West Hertfordshire Teaching Hospitals NHS Trust	Medium	Not reported	836	Not reported	957
West Suffolk NHS Foundation Trust	Small	Not reported	Not reported	Not reported	Not reported
Whittington Health NHS Trust	Multi-service	79	543	140	Not reported
Wirral University Teaching Hospital NHS Foundation Trust	Teaching	1,486	Not reported	Not reported	Not reported
Worcestershire Acute Hospitals NHS Trust	Large	2,074	2,074	2,199	3,031
Wrightington, Wigan and Leigh NHS Foundation Trust	Medium	227	195	211	203
Wye Valley NHS Trust	Multi-service	326	310	47	519
Yeovil District Hospital NHS Foundation Trust	Small	326	310	47	519
York and Scarborough Teaching Hospitals NHS Foundation Trust	Teaching	45	58	91	110

View this table in the data tables file

Acknowledgements

These reports would not be possible without the weekly contributions from microbiology colleagues in laboratories across England. The support from colleagues within UKHSA, and the AMRHAI Reference Unit in particular, is valued in the preparation of the report. Feedback and specific queries about this report are welcome via hcai.amrdepartment@ukhsa.gov.uk