Understanding the landscape of carbapenemase-producing organisms (CPOs), and spotlighting opportunities for control in England.

Carbapenemase-producing organisms (CPOs) are an increasing global public health threat for which there are limited effective and affordable therapeutic options. The rise in the incidence of CPO infections and colonisations recorded across the UK and beyond over the last 20 years necessitates a need to review and update strategies for control. It is important to review other countries' frameworks for CPO control and significant CPO outbreaks as these could inform the design of an efficient public health response. Despite many nations reacting to the rise by upscaling public health surveillance of CPOs (and the introduction of mandatory notification in England), improvements in laboratory detection methods, and the linkage of data across jurisdictions, significant challenges remain. For example, though predominantly acquired via cross-transmission between patients in healthcare, there are reports of human infections putatively acquired from CPOs harboured in the natural environment. Given the role of one-health in AMR, this is an important consideration. In this article, we outline some of the CPO control strategies adopted across different countries to give a sense of the global picture, and expand on why, in addition to controls in healthcare, there is a strong need to consider a One-Health approach. We describe the existing framework for CPO control in England and emphasise the importance of an integrated, multi-disciplinary and cross-sectoral strategy for dealing with the multifaceted problem posed by CPO in England.