UKHSA's latest CPE data show pressure rising in NHS hospitals
England's mandatory surveillance shows carbapenemase-producing organisms are still climbing, driven mainly by screening detections rather than invasive disease. For IPC teams, the signal is clear: regional spread is broadening, NDM remains ascendant, and hospital-network control matters more than single-site responses.
By June 2025, England had recorded 23,991 acquired carbapenemase-producing organism episodes since mandatory reporting began in October 2020, and the quarterly rate rose again, from 2.7 to 2.9 per 100,000 population between Q1 and Q2 2025. Most notifications were still coming from screening samples, 71.4%, not clinical infection, while 1,096 episodes, 4.6%, were linked to sterile-site specimens. That split matters. It suggests NHS hospitals are detecting more colonisation, but it also confirms a persistent reservoir that keeps feeding transmission risk across wards, trusts and transfer pathways. UKHSA Q2 2025 surveillance
What the latest UKHSA figures actually show
The newest UKHSA quarterly update does not point to a single national surge in invasive CPE disease. It shows something more operationally awkward, widespread pressure sustained by screening positivity, with clear regional concentration. In the year from Q3 2024 to Q2 2025, the highest annual rates were in London, the North West and the West Midlands, at 23.1, 20.5 and 20.5 per 100,000, respectively. At ICB level, the gap was even wider, from 36.9 per 100,000 in NHS Staffordshire and Stoke-on-Trent to 0.6 per 100,000 in Gloucestershire. UKHSA Q2 2025 surveillance
The mechanism profile is just as important for front-line planning. Over the last year, NDM accounted for 37.0% of reports, narrowly ahead of OXA-48-like at 35.7%, while KPC made up 18.4%. Regionally, the picture is mixed: NDM dominates in London, the East Midlands, the North East, the South West and the South East; OXA-48-like leads in the East of England, West Midlands and Yorkshire and the Humber; KPC still dominates in the North West. That matters for laboratory workflows, empirical assumptions about novel beta-lactam/beta-lactamase inhibitor activity, and the speed with which isolates should move to confirmatory testing. UKHSA Q2 2025 surveillance
Why this is an NHS hospital problem, not just a laboratory trend
UKHSA's earlier Q3 2024 report showed the quarterly rate had already reached 3.8 per 100,000 population, the highest since mandatory surveillance began, with 2,116 episodes in that quarter and the latest three quarters then showing the highest numbers of positive sterile-site specimens since reporting started. The Q2 2025 fall in sterile-site reports, from 94 to 67, is welcome, but it should not be over-read as control. The underlying burden remains high, and the dominant signal is continued acquisition identified through screening. UKHSA Q3 2024 surveillance UKHSA Q2 2025 surveillance
That fits the wider European picture. ECDC's February 2025 rapid risk assessment said the CRE situation across the EU/EEA is deteriorating, citing increased carbapenem-resistant Klebsiella pneumoniae bloodstream infection incidence in 23 EU Member States, spread of high-risk hospital lineages, plasmid-mediated transmission across facilities, and growing concern about carbapenemase-carrying E. coli. ECDC judged the risk of further spread as high to very high if current trends continue. England is not exceptional here, it is part of the same epidemiological drift. ECDC rapid risk assessment, February 2025
Detection is improving, but transmission still outruns control
Mandatory notification through SGSS has made English surveillance far more sensitive than it was before October 2020. That is a genuine gain. But surveillance is not containment. UKHSA's national framework still rests on familiar measures, risk assessment on admission, rapid screening of patients with exposure history, prompt isolation or cohorting, communication on transfer, and network-level oversight rather than trust-by-trust firefighting. UKHSA CPE framework
Recent peer-reviewed work reinforces that point. A 2024 Clinical Infectious Diseases study on the natural history of CPE found that progression from carriage to bloodstream infection varies by organism, carbapenemase and clinical setting, supporting the argument that colonised patients are not a benign denominator. Meanwhile, hospital studies using genomic surveillance continue to show mixed clonal and plasmid-mediated spread, often crossing species and ward boundaries, exactly the kind of transmission that standard line lists can miss. Clinical Infectious Diseases, 2024 ICHE genomic surveillance study
Implications for IPC teams
For NHS acute trusts, three points stand out. First, the burden is still being driven by screen-detected acquisition, so admission and contact screening policies remain central, especially in high-incidence regions and high-dependency pathways. Second, NDM is now the leading mechanism nationally, which should sharpen both laboratory detection algorithms and stewardship discussions because not all newer agents retain activity against metallo-beta-lactamase producers. Third, regional coordination matters. Transfers between hospitals, step-down units and care settings can sustain CPE circulation even when one site believes it has contained its own problem. CDC CRE infection control guidance WHO CRE prevention and control guideline
For IPC leaders, the headline is not simply that CPE numbers are up. It is that English hospitals are now managing a mature, regionally embedded threat in which colonisation pressure, inter-facility movement and mechanism shift increasingly define the workload.
Over the next 6 to 12 months, expect UKHSA reports to keep showing marked regional heterogeneity rather than a uniform national curve. The harder question is whether high-burden systems can convert better detection into lower transmission. If they cannot, screening positivity today will become tomorrow's invasive disease, and more of it will be NDM-linked.