Is mandatory surveillance of carbapenemase-producing Gram-negative organisms working? A surveillance evaluation, England, 2020-2023.

BACKGROUND

Carbapenemase-producing organisms (CPOs) are an increasing public health threat. In October 2020, English laboratories were mandated to report acquired CPO detections in Gram-negative organisms from human clinical samples and screens to the existing national laboratory reporting system.

AIM: The aim of this study was to describe acquired CPO epidemiology and evaluate the laboratory coverage, data quality, timeliness, simplicity and acceptability of the mandatory surveillance system.

METHODS

Using a mixed-method approach, we extracted laboratory-confirmed CPO reports from 1st October 2020 to 31st December 2023 to assess laboratory coverage (proportion of laboratories reporting at least one CPO to the Second Generation Surveillance System in 2023) and data quality (completeness of variables). We conducted semistructured interviews with stakeholders to assess simplicity, acceptability and perceived timeliness via thematic analysis.

FINDINGS: Reports of acquired CPO episodes in England doubled, from 2,670 (2021) to 5,759 (2023), with regional variation in rates (London: 21.3/100,000 population vs South-West: 1.8/100,000). In 2023, laboratory coverage was 72% (83/115), from 38 to 100% by region. Data quality was high. Participants (N = 12) described laboratory reporting delays due to technical issues, limited staff capacity or human error but were satisfied with the timeliness of surveillance outputs for monitoring longer-term trends. Mandatory reporting was acceptable, and some participants experienced streamlined, automated reporting, whereas others noted complicated or manual workarounds using pre-existing systems.

CONCLUSIONS

Reported CPO incidence is increasing, and CPO surveillance is perceived as efficient, valuable and acceptable. However, despite being mandatory, laboratory reporting is still not comprehensive. We recommend investing in improvements to the existing surveillance system, ensuring that all laboratories have capacity to report and optimise processes.