Fig. 5: Workflow of sample collection and processing.

Diagram detailing the total number of hospital surface swabs (HSS) collected, showing Gram-negative bacteria (GNB) growth, and screened for the presence of blaCTX-M-15, blaNDM, blaKPC and blaOXA-48-like antimicrobial resistance genes (ARGs), the number of GNB isolates recovered carrying carbapenemase genes, the number of isolates characterised by whole genome sequencing (WGS) and, where WGS data was sufficient, bioinformatic analysis was performed. Isolates for WGS were chosen after culture on VE (vancomycin, ertapenem) agar. Recoverable isolates after −80 °C preservation were selected for gDNA extraction and WGS. Data cleaning is also detailed; where data regarding hospital surfaces and collection dates was available, statistical analysis and data analysis were performed.