Type of publication:
Journal article
Author(s):
Baltas I.; Drury K.; Harrison T.; Moore N.; Lester R.; Chattaway M.A.; England B.; Cattrall J.W.S.; Donaldson C.J.; Jamal Khan D.P.; Carroll A.; Ball D.; Wareham D.W.; Pahalage R.; Banavathi K.; Drazho B.; Shorrocks R.E.; Hlaing W.; Adhikaree N.; Ryan F.; Thompson J.V.; Connolly G.; Shibu P.; Ale E.; Mirfenderesky M.; Jain S.; Fowler S.; Beard K.; Hughes G.; Bonnici G.; Mohammed T.; Brown K.; Drazich-Taylor S.; Martinez A.S.; Lipworth S.; Crawford-Jones D.; Elnour M.; Moore J.; Democratis J.; McCormick J.; Hussain A.; Islam J.; Jenkins D.; Stoesser N.; Hopkins K.; Demirjian A.; Hatcher J.; Soares A.L.; Kirby A.; Grandjean L.; Riley U.; Stephens J.; Joseph A.; Winzor G.; Jackson K.E.; Kandil H.; Barker B.; Planche T.; Jawad S.; Merrick B.; Snell L.B.; Subbaraj K.P.; Munthali P.G.; Clayton J.J.; Varghese R.; Jones C.R.; Hardman N.L.; Komosa M.M.; Heppell B.M.; Halstead F.D.; Qaiser S.; Mavrogiorgou E.; Nye C.; Bamber S.; Locke T.E.; Whatmore J.; Mohamed F.; Adobah E.; Knox K.; Campbell O.; Carson A.A.; North P.; Albur M.; Tickell-Painter M.; Mooney H.; Coward A.; Shah A.; Choudhury R.Y.; Sughayer H.M.; Graham C.; Mutch C.P.; Dewar S.; Hesing S.C.; Khan S.; Garcia-Mingo A.; Garcia D.M.; Penciu F.; Kosaraju K.; Davey E.; Vazquez A.M.; Qazzafi Z.; *Anand M.; Navalan H.; Roberts S.; Mermerelis D.; Read A.; Rangaiah J.; Austin-Hutchison R.; Price J.R.; Peters J.; Stevens M.; Knapper F.; Merchant N.; Davies F.; Vanstone G.L.; Allen D.; Prior-ong M.; Tuharska Z.; Soper I.; Tsui R.; Watts A.; Kakkar N.; Patel M.; Townsley H.; Saajan P.; Claxton A.P.; Burns P.J.; Jeppesen C.A.; Lee M.; Tudor A.; Macnaughton E.; McKeating C.; Dhillon R.; Okoliegbe I.; Sakka N.E.; Scott K.S.; Wang D.B.; Wilson B.; Laing-Herridge K.; Diver-Hall E.
Citation:
International Journal of Antimicrobial Agents. 67(10) (no pagination), 2026. Article Number: 107898. Date of Publication: 01 Oct 2026. [epub ahead of print]
Abstract:
Background Carbapenem-resistant Enterobacterales (CRE) are increasing in the UK, but the drivers of this rise and effective treatment options remain uncertain. Methods Ninety-seven acute National Health Service Trusts, including 192 UK hospitals, submitted data on 8840 consecutive, non-duplicate CRE (October 2023 to September 2024) and local laboratory methods. Results Predominant CRE species were Klebsiella pneumoniae (30.6%, 2709/8840), Escherichia coli (29.3%, 2592/8840), Enterobacter cloacae complex (22.2%, 1966/8840). Overall, 21.8% (1927/8840) of CRE were collected in outpatient settings. Overall, 85.5% (7279/8513) of CRE underwent carbapenemase detection testing, with significant variation depending on species, specimen type, and baseline antibiogram. Carbapenemases detected were OXA-48-like (22.3%, 1967/8840), NDM (18.6%, 1645/8840), KPC (9.2%, 817/8840), IMP (2.0%, 178/8840), VIM (0.7%, 62/8840), multi-carbapenemase producers (4.0%, 351/8840). Overall, 51.2% (4526/8840) of CRE were tested against >=1 novel agent. In-house antimicrobial susceptibility testing availability was common for ceftazidime-avibactam (90.7%, 88/97) and cefiderocol (73.2%, 71/97), while less common for meropenem-vaborbactam (41.2%, 40/97), imipenem-relebactam (21.6%, 21/97), aztreonam-avibactam (11.3%, 11/97). OXA-48-like- (97.6%, 1138/1166) and KPC producers (96.2%, 429/446) remained susceptible to ceftazidime-avibactam; KPC producers to meropenem-vaborbactam (99.4%, 160/161) and imipenem-relebactam (98.4%, 62/63). Cefiderocol resistance was 32.4% overall and higher among NDM- (58.4%) and multi-carbapenemase producers (50.3%). Ceftazidime-avibactam plus aztreonam synergy was performed for 17.2% (286/1658) of aztreonam-resistant metallo-beta-lactamase-producers; synergy was observed in 78.7% (225/286) of cases. Colistin resistance was 10.6% (153/1445) among non-intrinsically resistant species. Conclusions Whilst most UK CRE are tested for carbapenemases, coverage gaps persist. The community burden of CRE is increasing. Cefiderocol resistance is concerningly high, particularly among metallo-beta-lactamase-producers.
DOI: 10.1016/j.ijantimicag.2026.107898
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