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Antimicrobial resistance in E. coli bacteriuria in acute trust settings, percent of resistance testing by month

Last updated on Thursday, 31 July 2025 at 11:59am

Summary

Topic
E-coli
Category
testing
API name
e-coli_testing_bacteriuriaPercentTestedRollingMonthAcuteTrust

Rationale

Timely monitoring of susceptibility test results for Escherichia coli (E. coli) supports the government’s 5-year action plan on confronting antimicrobial resistance (AMR; for example, resistance to antibiotics). Antimicrobials presented in this metric have been selected due to their clinical importance when treating E. coli infections in urine specimens.

Methodology

A national database maintained by UK Health Security Agency (UKHSA; the AMR module of SGSS – Second Generation Surveillance System) contains voluntary laboratory data from approximately 98% of hospital microbiology laboratories in England. Data on susceptibility of pathogens was obtained from SGSS for this metric. Patients may have more than one positive culture (type of laboratory test undertaken on urine specimens) result reported to SGSS, so cultures from the same patient for the same pathogen in a 14-day rolling period are deduplicated to only retain one result representing that episode of bacteriuria per patient. If susceptibility to the antimicrobial was tested for in any culture during the episode, it will be counted in this metric. This metric is calculated by dividing the total number of E. coli bacteriuria episodes by the number of E. coli bacteriuria episodes with susceptibility test results for nitrofurantoin or trimethoprim by month, and averaging the result for each month with the previous two months, to create a three-month rolling average. Results are multiplied by 100 to be viewed as a percentage.

Specimen setting was defined using fields available in SGSS AMR and Trust data available from the 2023/24 Estates Return Information Collection (ERIC). Acute Trust specimens are those recorded by the laboratory as being taken in an acute trust setting or those with site codes that matched an ‘Acute’ trust type in ERIC. Presentation by setting may be impacted by local laboratory data reporting, whereby laboratories that do not differentiate between specimen settings may inaccurately represent the split in Acute Trust versus GP specimen setting for that area.

Caveats

Combining patient results into one infection episode is limited by the provision of key identifiers by reporting laboratories, so some episodes may be counted more than once if these identifiers enabling grouping and de-duplication are not provided or are provided incorrectly.

The data reflects microbiology results reported to the UKHSA routine laboratory surveillance system antimicrobial testing module (SGSS AMR). Not all laboratories in England were able to report during the indicator time period, which may impact the value being reported in an area.

Hospital microbiology laboratories have reported antimicrobial susceptibility test results as ‘susceptible’, 'susceptible, increased exposure’ or ‘resistant’. These categories were defined as follows as per the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoints can change over time and this has implications for interpretation of resistance trends spanning breakpoint changes; please see ESPAUR 2023/24 report box 2.3 for further explanation.

SGSS is a live reporting database, and therefore data is subject to change and may differ to other published outputs.

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