Carbapenems are a powerful group of broad spectrum beta-lactam (penicillin-related) antibiotics which, in many cases, are our last effective defence against multi-resistant bacterial infections. What is of concern, however, is that resistance is beginning to emerge to carbapenems. New antibiotics need to be developed to counter bacteria with this type of resistance; what is more, hospitals need good infection control to prevent their spread.

The HPA conducts monitoring and surveillance on antibiotic resistance in the UK and has done so since the late 1980s.

Surveillance is currently being undertaken for isolates that have been submitted to ARMRL and found to be carbapenemase-producers. The carbapenemase monitoring form should be completed by Microbiologists or Healthcare workers involved with care of the patient from whom carbapenemase-producing bacteria has been isolated.  Completed forms should be returned by encrypted email, fax or post using the instructions outlined on the form.  If you need any assistance with completion of this document or require it in an alternative format then please email Carbapenemase@hpa.org.uk outlining your query.

A downloadable version of the ARMRL carbapenemase monitoring form is available:

• Carbapenemase-producing isolates data collection form (PDF, 227 KB) 
• Carbapenemase-producing isolates data collection form (Excel Spreadsheet, 72 KB)

Scientists from the Health Protection Agency recently co-authored a paper published in The Lancet Infectious Diseases on the emergence of a new antibiotic resistance mechanism - New Delhi metallo beta lactamase (NDM-1).  This is an enzyme that inactivates carbapenem antibiotics.  It is coded by loops of DNA -plasmids- that can move between bacteria.  Bacteria with NDM are most widespread in the Indian subcontinent but have spread to various countries around the world, including the UK, often via patients previously hospitalized in India or Pakistan.

Most bacteria with the NDM-1 enzyme do remain susceptible to two types of antibiotics -colistin and tigecycline- neither of which is ideal for general use. A few isolates with NDM are completely resistant to antibiotics, including colistin and tigecycline.

Other carbapenem-destroying enzymes have been seen around the world, but the producer bacteria are rarely so resistant as those with NDM-1.

More Information is available about the surveillance programmes by the antibiotic resistance monitoring and reference laboratory.

Business enquiries from pharmaceutical companies should contact the Antibiotic Resistance Monitoring and Reference Laboratory.

The Health Protection Agency conducts research on antibiotic resistance, including carbapenemases such as NDM-1, and undertakes laboratory assessment of new antibiotics against bacteria with these mechansims.  See details of current research.

Alerts were sent out about the emergence of resistance to carbapenems in January and July 2009.