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Main messages

Main messages from this report are that:

• between October 2020 and March 2025, there were 22,237 acquired carbapenemase-producing organism (CPO) episodes reported to UKHSA. The majority were identified in screening samples, accounting for 71.3% of notifications, with 1,012 (4.6%) reported from sterile site specimens
• the quarterly rate of reported CPO episodes in Q1 2025 (2.7 per 100,000 population) decreased from Q4 2024 (3.2 per 100,000 population). The decrease was concentrated in the North West, London, and North East, which reported markedly fewer positive screening samples (a decrease of 30.2%, 29.8%, and 18.1% respectively)
• there were 92 sterile site CPO specimen reports in Q1 2025, following the 90 specimens reported in Q4 2024; the latest three quarters seeing the highest numbers of positive sterile site specimens reported since mandatory surveillance began
• the highest rates of CPO continue to be in London, the North East and the North West regions (25.8, 21.8, and 21.5 per 100,000 population, respectively), with NHS North West London ICB having the highest rate (38.4 per 100,000 population) and NHS Gloucestershire ICB having the lowest (0.6 per 100,000 population)
• the most reported acquired carbapenemase family in the last year (Q2 2024 to Q1 2025) was New-Delhi metallo (NDM) (36.3%), followed by OXA-48-like (34.4%) and Klebsiella pneumoniae carbapenemase (KPC) (19.6%); however, this varied by region: in London, the East Midlands, the North East, the South West and the South East, NDM was the most reported mechanism; OXA-48-like was the most reported mechanism in the East of England and the West Midlands; whereas KPC continued to dominate reports in the North West
• no changes occurred in CPO distribution across demographic groups (age and sex, ethnic group and index of multiple deprivation (IMD) decile) since the last report

Background

Since 1 October 2020, all diagnostic laboratories in England have a duty to notify the following via 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 .

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, can help health and social care providers minimise the impact of carbapenemase-producing organisms (CPOs).

The analyses below are based on data relating to notifications of CPOs confirmed to produce an acquired carbapenemase (‘acquired CPOs’) between 1 October 2020 and 31 March 2025 in England. The data was extracted on 16 May 2025 from both UKHSA’s voluntary surveillance database, SGSS, and the Antimicrobial Resistance and Healthcare-Associated Infections (AMRHAI) Reference Unit‘s database.

Both annual and quarterly rates of acquired CPOs were calculated using for the respective year (where available, or the closest available year as a proxy) and geography. Geographical analyses were based on the patient’s residential postcode; where this information was unknown, the postcode of the reporting laboratory was used. Cases in England were further assigned to one of nine local areas and one of 42 integrated care boards (ICBs), formed from the administrative local authority boundaries and . The annual rates of acquired CPOs by geographical region included in this report differ slightly from those calculated in some previous reports due to a methodological adjustment made following the identification of an inconsistency in the methodology of previous reports. Previous reports will be corrected accordingly.

Samples are split into three specimen types: sterile site specimens (for example, blood or cerebrospinal fluid), screening site specimens (for example, faeces or lower gastrointestinal tract) or ‘other’ specimen type (for example, urine or lower genital tract). In order to count patients per year with a CPO, and as patients may have more than one positive specimen taken, specimens taken from the same patient that yielded growth of the same bacterial species, had the same carbapenemase gene and were from the same specimen type within a 52-week period from the initial positive specimen were regarded as comprising the same episode and were de-duplicated. CPO isolates referred to the AMRHAI Reference Unit 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 (please note, not all specimens in this report are confirmed by the AMRHAI Reference Unit). This method differs slightly from the weekly causative agent notification data, where data are not de-duplicated incorporating specimen type. In addition, the data presented in the weekly notification reports are utilising SGSS reports only.

Each carbapenemase in the report is presented as a separate mechanism and not as a combination (eg NDM + OXA-48-like), unless specified.

The is a way of summarising the level of deprivation within an area, based on a set of factors that includes its residents’ levels of income, employment, education and local levels of crime. Episodes were linked to IMD using patients’ residential postcode (and laboratory postcode where patient postcode was unavailable) and the IMD decile score was identified by the the patient resided in.

The Office for Health Improvements and Disparities developed a method for assigning ethnic group based on hospital admissions data. As different ethnicities may be recorded in different treatment episodes, the method selected a single ethnic group from a patient’s Hospital Episode Statistics (HES) records. Individuals who did not have an ethnic group documented in HES were linked to Emergency Care Data Set (ECDS) to enhance completion. Episodes were linked to an ethnic group using the patient’s NHS number and date of birth.

The following report summarises trends and geographical distribution of carbapenemase mechanisms identified in Gram-negative bacteria isolated from human samples. Bacterial species, mechanism, sample type, age, sex, IMD and ethnic group 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 ‘Q2’, July to September is ‘Q3’ and October to December is ‘Q4’.

Please note that 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 antimicrobial susceptibility testing results, laboratories should contact UKHSA’s Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit in Colindale, London.

Table 1 summarises the carbapenemase gene families that are targeted using the PCR applied to referred Enterobacterales, Pseudomonas spp. and Acinetobacter spp. that are suspected to harbour an acquired carbapenemase gene. UKHSA strongly recommends that all diagnostic laboratories seek at least the four carbapenemase families in bold in the table (the ‘big 4’) using either PCR or immunochromatographic methods.

Where an ‘exceptional’ carbapenemase and genus 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 among bacterial pathogens of carbapenemase genes covered by AMRHAI Reference Unit’s molecular assay (based on AMRHAI data) [note 1]

Carbapenemase gene families	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	¥	<50E	0
NDM	¥	¥	¥
VIM	¥	¥	<10D
IMP	¥	¥	¥
IMI/NMC-A	Â¥µþ	0	0
GES	¥	¥	<10D
FRI	&±ô³Ù;10Ìý¶Ù	0	0
SME	¥ C	0	0
DIM	0	<50E	0
GIM	<10D	<10D	0
SIM	0	<10D	0
SPM	0	<10D	0
OXA-23-like	<50E	0	¥
OXA-40-like	0	0	¥
OXA-51-likeA	0	0	¥
OXA-58-like	0	0	¥

Note 1. Table 1 uses the following symbols:

Â¥ = combinations of mechanism and genus are not considered exceptional.

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 confirmed by AMRHAI Reference Unit.

E = fewer than 50 in total ever confirmed by AMRHAI Reference Unit

Recent developments

Of the unusual carbapenemase and genus combinations referred to the AMRHAI Reference Unit in Q1 2025, one included a DIM metallo-carbapenemase-positive Pseudomonas putida referred from the East Midlands (from a rectal swab). Six GES carbapenemase-positive isolates were also referred: three Pseudomonas aeruginosa (two from the North East and one from London; isolated from bronchoalveolar lavage, urine and an ear swab), and one each of Enterobacter cloacae complex (body fluid), Citrobacter freundii (rectal swab) and Klebsiella pneumoniae (rectal swab).

As DIM and GES genes are not detected using diagnostic assays that target the ‘big 4’ or ‘big 5’ carbapenemase families (‘big 5’ includes IMP), laboratories are reminded to refer isolates that meet AMRHAI referral criteria (2) to the Reference Unit for screening for rarer carbapenemase genes.

The most common dual carbapenemase combination observed amongst Reference Unit referrals was NDM + OXA-48-like. However, in Q1 2025 the following combinations were also identified: one each of IMP + NDM (in P. aeruginosa), KPC + NDM (in Klebsiella pneumoniae), VIM + NDM (in Citrobacter sp.) and VIM + OXA-48-like (in Citrobacter sp.). Isolates with these combinations are currently rare amongst AMRHAI submissions and should be referred for confirmation (free-of-charge for NHS laboratories) and inclusion in the AMRHAI strain collection.

Locally-confirmed unusual combinations of organism and mechanism should also be referred to the AMRHAI Reference Unit for confirmation. Follow up of these unusual combinations has identified some have been due to mixed cultures or reporting errors.

Specimen type

Between October 2020 and March 2025, there were 22,237 acquired CPO episodes reported. The majority were identified in screening samples, accounting for 71.3% of notifications, with 1,012 (4.6%) reported from sterile site specimens (Table 2).

Table 2. Number and percentage of acquired CPO episodes by specimen type (England): October 2020 to March 2025

Specimen type	All reports number	All reports percentage [note 3]	AMRHAI reports number	AMRHAI reports percentage [note 4]
Sterile site	1,012	4.6	312	10.3
Other clinical samples [note 2]	5,366	24.1	1,279	42.2
Screening	15,859	71.3	1,440	47.5
All samples	22,237	100	3,031	100

Note 2. Samples that did not fall into either ‘sterile site’ or ‘screening’ samples, for example, urine and lower genital 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

For Q2 2024 to Q1 2025, the overall annual rate of CPO episodes in England was 13.1 per 100,000 population. The quarterly rate of CPO episodes decreased from 3.2 CPO episodes per 100,000 in Q4 2024 to 2.7 episodes per 100,000 in Q1 2025 (Figure 1). This decrease was predominantly due to a 19.4% decrease in positive screening samples between Q4 2024 and Q1 2025 (n=1,312 to 1,058). The decrease was concentrated in the North West, London, and the North East, which reported markedly fewer positive screening samples (a decrease of 30.2%, 29.8%, and 18.1%, respectively) (see accompanying data tables, Data Appendix 1). However, the number of sterile site samples remained stable (n=90 episodes in Q4 2024 to 92 in Q1 2025) (Figure 1), with the number of reported sterile site infections more than doubling from Q4 2020 to Q1 2025 (see accompanying data tables).

Changes to screening policies, outbreaks, and/or an improvement in national reporting of CPO episodes can have a substantial impact on overall CPO trends; it is therefore important to note that the reported increase in CPO episodes may be due in part to changes in screening policies and improved reporting over time. There appears to be seasonality in the number of positive reported screening samples, with peaks in Q3 over the last three years and subsequent drops in Q1. However, caution should be taken when interpreting seasonal trends, especially for ‘other’ and sterile site specimens, and local outbreaks may influence sampling and incidence.

Figure 1. Quarterly rate of acquired CPO episodes by specimen type and quarter (England): October 2020 to March 2025

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

Epidemiology of CPO episodes over the last year (Q2 2024 to Q1 2025)

The data summaries in the rest of this report consider all sample types grouped together and only for the past rolling year (April 2024 to March 2025), using both annual and quarterly rates.

Geographical distribution

The annual rate of acquired CPO episodes varied by region (Office for National Statistics (ONS) regions) (Figure 2a), with the highest overall rate between April 2024 and March 2025 reported in London (25.8 episodes per 100,000 population), followed by the North East (21.8 episodes per 100,000 population) and the North West region (21.5 episodes per 100,000 population). The lowest annual incidence during the last year was reported in the South West region (2.6 episodes per 100,000 population).

At the Integrated Care Board (ICB) level, NHS North West London ICB had the highest rate of reports (38.4 episodes per 100,000) followed by NHS Staffordshire and Stoke-on-Trent ICB (34.3 episodes per 100,000 population) and NHS Greater Manchester ICB (32.2 episodes per 100,000 population) (Figure 2b). The lowest annual incidence during the last year was reported in the NHS Gloucestershire ICB (0.6 episodes per 100,000 population). Regional and ICB variation can be due to differences in incidence, as well as variation in screening policies, outbreaks and reporting to national surveillance.

Figure 2a. UKHSA regional distribution of acquired CPO annual incidence rates per 100,000 population (England): April 2024 to March 2025 [note 5]

Figure 2b. Integrated Care Board (ICB) regional distribution of acquired CPO annual incidence rates per 100,000 population (England): April 2024 to March 2025 [note 5]

Note 5. The region geography is based on the patient’s residential postcode (if unknown, the laboratory location was used) and linked to the ONS data for regions (Figure 2a) and ONS data for ICBs (Figure 2b). Fourteen CPO episodes were excluded as the reporting laboratory could not be linked to an ICB, due to the lab not being registered to a known ICB.

The numbers and quarterly rates of reported acquired CPO episodes for each ONS region by calendar quarter are shown in Table 3. The quarterly rate of reported CPO episodes in ONS regions decreased between Q4 2024 and Q1 2025 in most regions. The largest decrease in rates from Q4 2024 and Q1 2025 was seen in the North West (5.2 to 3.8 per 100,000 population) and London (6.2 to 4.9 per 100,000 population). Only in the South East did the rate increase between Q4 2024 and Q1 2025 (1.7 to 1.9 per 100,000).

Table 3. Number of acquired CPO episodes and quarterly rate per 100,000 population for all specimen types by ONS region (England): April 2024 to March 2025

ONS region	Number (n) (rate per 100,000 population) of 2024 Q2	Number (n) (rate per 100,000 population) of 2024 Q3	Number (n) (rate per 100,000 population) of 2024 Q4	Number (n) (rate per 100,000 population) of 2025 Q1
London	679 (7.6)	629 (7.0)	559 (6.2)	438 (4.9)
West Midlands	272 ( 4.5 )	359 (5.9)	304 (5.0)	293 (4.8)
North West	423 (5.6)	523 (6.9)	399 (5.2)	287 (3.8)
North East	190 (7.0)	182 (6.7)	119 (4.4)	101 (3.7)
Yorkshire and the Humber	89 (1.6)	102 (1.8)	138 (2.5)	118 (2.1)
South East	120 (1.3)	155 (1.7)	152 (1.7)	170 (1.9)
East of England	77 (1.1)	80 (1.2)	92 (1.4)	85 (1.3)
East Midlands	85 (1.7)	60 (1.2)	54 (1.1)	47 (0.9)
South West	36 (0.6)	33 (0.6)	51 (0.9)	29 (0.5)
England	1,971 (3.4)	2,123 (3.7)	1,868 (3.2)	1,568 (2.7)

Geographical differences in carbapenemase family distribution

Between April 2024 and March 2025, the most common carbapenemase families reported across all regions were NDM (36.3%), OXA-48-like (34.4%), and KPC (19.6%), although the distribution of carbapenemase families identified varied regionally (Figure 3). The diversity of carbapenemases reported in regions may be impacted by individual outbreaks, especially in regions with small numbers of cases or in trends over time for less commonly identified mechanisms.

In London, which had the highest annual incidence rate, the most reported carbapenemase families were NDM (47.2%) and OXA-48-like (37.7%). In contrast, KPC (42.0%) remained the dominant carbapenemase family in the North West. KPC was not as common in the other regions, accounting for fewer than a third of episodes in each region; in London, KPC accounted for only 4.1% of episodes.

The largest proportion of reported IMP were from the North East (22.6%), Yorkshire and the Humber (14.5%), and South West (12.1%); other regions ranged between 2.2% and 6.4%. Nationally, reported IMP represented 6.9% of all CPOs.

The distribution of carbapenemase families varied in each quarter in some ONS regions (see accompanying data tables, Data Table Appendix 2). For example, the most reported carbapenemase family in Yorkshire and the Humber was KPC in Q2 2024 (29.2%, n=26), but switched to OXA-48-like in Q1 2025 (38.1%, n=45), followed by KPC (26.3%, n=31).

Figure 3. Geographical distribution of acquired CPO episodes by carbapenemase family (England): April 2024 to March 2025 [note 6]

Note 6. Other carbapenemase families included DIM, GES, IMI, and OXA-23 (in Enterobacterales).

Distribution of species and carbapenemase family

Between April 2024 and March 2025, the most frequently isolated Gram-negative bacterial species with an acquired carbapenemase were Escherichia coli (34.0%), Klebsiella pneumoniae (32.7%) and Enterobacter spp. (18.2%) (Figure 4).

The carbapenemase family most frequently identified in E. coli and K. pneumoniae isolates was OXA-48-like (48.7% and 32.3%, respectively). Escherichia coli, NDM (39.4%) and KPC (8.3%) were the next most frequently identified carbapenemase families; however, in K. pneumoniae it was KPC (31.9%) and NDM (29.8%). In Enterobacter spp., the most common carbapenemase family was NDM (39.7%), followed by KPC (20.5%), OXA-48-like (18.3%), and IMP (18.3%).

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 to produce an acquired carbapenemase but that test negative for the ‘big 4’ or ‘big 5’ carbapenemase families (depending on the testing capabilities of the local laboratory) are referred to the AMRHAI Reference Unit for further testing. Between October 2020 and March 2025, DIM, GES, GIM, IMI, OXA-23 (in Enterobacterales) and SME carbapenemases were identified in small numbers of isolates and represented 2.8% of all reports.

Figure 4. Proportional split of carbapenemase family by organism (England): April 2024 to March 2025

Note 6. ‘Other’ carbapenemase families included DIM, GES, OXA-23 (In Enterobacterales), and IMI  Isolates identified as positive for ‘Other’ carbapenemase families should be referred to the AMRHAI Reference Unit for confirmation.

Note 7. KPC and OXA-48-like in Pseudomonas spp. and Acinetobacter spp. are extremely rare, and positive results should be interpreted with caution. Laboratories identifying these unusual combinations should refer such isolates to the AMRHAI Reference Unit.

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 isolates reported here have not all been confirmed by the AMRHAI Reference Unit and laboratories identifying these unusual combinations should refer such isolates to AMRHAI.

Distribution of demographic risk factors

Between April 2024 and March 2025, the annual rate of reported acquired CPO episodes was highest among the oldest and youngest members of the population. A similar age pattern was noted for both sexes, although overall the annual rate was higher in males compared with females (overall rates of 14.6 and 11.5 episodes per 100,000 population, respectively; Figure 5). This aligns with the age group and sex distribution noted in previously published reports for Gram-negative bacteraemia caused by E. coli, Klebsiella spp., P. aeruginosa and Enterobacter spp.

Figure 5. Annual rate of acquired CPO episodes per 100,000 population by age and sex [note 10] (England): April 2024 to March 2025

Note 10. Information about patient sex is recorded in 99.5% of cases.

Figure 6 shows the reported acquired CPO annual incidence rates by ethnic group and sex between April 2024 and March 2025, with the highest annual rate reported in those of Asian or Asian British ethnicity (25.2 per 100,000 population), followed by those of Black, Black British, Caribbean or African ethnicity (18.5 per 100,000 population). A similar pattern was noted for both sexes, although overall the annual rate was higher in males compared with females (Figure 6).

Figure 6. Annual rate of acquired CPO episodes per 100,000 population by ethnic group [note 11] and sex [note 10] (England): April 2024 to March 2025

Note 10. Information about patient sex is recorded in 99.5% of cases.

Note 11. Information about patient ethnicity is recorded in 93.3% of cases.

The most common carbapenemase families identified in individuals of Asian or Asian British ethnicity were NDM (56.0%, n=765) and OXA-48-like (35.0%, n=478) (Figure 7). KPC was not as commonly identified in patients of Asian or Asian British ethnicity (4.5%, n=61) as it was in those of White ethnicity, where KPC accounted for 25.6% of episodes (n=1,285).

Figure 7. Distribution of acquired carbapenemase families by ethnic group [note 11] and (England): April 2024 to March 2025

Note 6. ‘Other’ carbapenemase families included DIM, GES, OXA-23 (in Enterobacterales), and IMI. Isolates identified as positive for ‘Other’ carbapenemase families should be referred to the AMRHAI Reference Unit for confirmation.

Note 11. Information about patient ethnicity is only recorded in 93.3% of cases.

Figure 8 shows the acquired CPO annual incidence rates by IMD decile and sex between April 2024 and March 2025. The highest annual rate was reported in those in the most deprived decile (first decile, 20.3 per 100,000 population). The annual rate generally declines as the IMD decile increases, with the lowest annual rate reported in the ninth IMD decile (7.7 per 100,000 population). A similar pattern was noted for both sexes, although overall the annual rate was higher in males compared with females (Figure 8).

Figure 8. Annual rate of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and sex [note 10] (England): April 2024 to March 2025

Note 10. Information about patient sex is only recorded in 99.5% of cases.

Note 12. Information about patient IMD is only recorded in 99.8% of cases.

Figure 9 shows the acquired CPO incidence annual rates by IMD decile and carbapenemase family between April 2024 and March 2025. The three carbapenemase families with the highest annual rates across all IMD deciles are OXA-48-like, NDM, and KPC (Figure 9).

Figure 9. Annual rate of acquired CPO episodes per 100,000 population by index of multiple deprivation decile and resistance mechanism (England): April 2024 to March 2025

Note 6. ‘Other’ carbapenemase families included DIM, GES, OXA-23 (in Enterobacterales), and IMI (in Enterobacterales). Isolates identified as positive for ‘Other’ carbapenemase families should be referred to the AMRHAI Reference Unit for confirmation.

Quarterly mandatory laboratory return reporting (April 2024 to March 2025)

Reporting of quarterly totals of rectal swabs and faecal specimens taken for CPO screening was added to the mandatory quarterly laboratory returns (QMLR) section of the HCAI DCS in October 2019, and reporting became mandatory in October 2020. In Q1 2025, there were 172,062 screens reported by 94 NHS Trusts, representing an overall Trust reporting rate of 70.1% (Table 4). As of the writing of this report, 13 (10.7%) Trusts had not reported any screens and an additional 2 (1.5%) Trusts reported zero screens between Q2 2024 and Q1 2025. The lower report rate for Q1 2025 may be due to late reports as the report rate for Q4 2024 has changed since the previous report (3).

The full list of reporting, including those that did not submit a return, is available in the data tables by individual NHS Acute Trust (Appendix table 3).

Table 4. Quarterly mandatory laboratory returns (QMLR) for the total number of rectal swabs and faecal screening specimens taken for CPO screening by acute Trust type [note 12] (England): April 2024 to March 2025

Trust type [note 12]	Q2 2024 reported screens (%)	Q2 2024 total number screens	Q3 2024 reported screens (%)	Q3 2024 total number screens	Q4 2024 reported screens (%)	Q4 2024 total number screens	Q1 2025 reported screens (%)	Q1 2025 total number screens
Large (n=23)	20 (87.0)	20,720	20 (87.0)	21,940	20 (87.0)	24,353	17 (73.9)	18,631
Medium (n=20)	20 (100.0)	10,127	19 (95.0)	12,157	19 (95.0)	11,584	14 (70.0)	11,967
Multi-service (n=7)	7 (100.0)	10,831	7 (100.0)	10,990	6 (85.7)Ìý	12,112	6 (85.7)	14,257
Small (n=23)	14 (73.7)	7,268	14 (73.7)	8,240	11 (57.9)	5,743	9 (47.4)	4,770
Specialist (n=16)	14 (87.5)	8,417	14 (87.5)	13,881	14 (87.5)	12,827	15 (93.8)	13,556
Teaching (n=50)	45 (91.8)	142,999	43 (87.8)	132,717	43 (87.8)	137,950	33 (67.3)	108,881
Total (n=135)	120 (89.6)	200,362	117 (87.3)	199,925	113 (84.3)	204,569	94 (70.1)	172,062

Note 12. Trust type obtained through (ERIC).

References

1. Department of Health and Social Care (2020).
2. UK Health Security Agency (2023). Bacteriology reference department user manual
3. UK Health Security Agency (2024). Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q4 2024

Acknowledgements

These reports would not be possible without the weekly contributions from microbiology colleagues in laboratories across England. The support from colleagues within the UK Health Security Agency, 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