Manchester City boss Pep Guardiola will need his medical staff to work overtime amid a hugely worrying claim.

The defending Premier League champions are dropping like flies as two more stars were added to City’s mounting casualty ward on Wednesday.

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Manuel Akanji had to withdraw from City’s Carabao Cup clash against Tottenham after he sustained a calf injury during the warm-up while electric winger Savinho was stretchered off in the second half with an ankle injury.

Star defender Ruben Dias was also substituted at half-time, although that appeared to be only a precautionary measure.

With the injuries piling up, Guardiola conceded his team are ‘in trouble’ and made a startling revelation about how many fit players he has to work with.

“We have 13 players, we are in real difficulties,” Guardiola said after the 2-1 loss to Tottenham.

“The guys that play, they finish most of them with problems and we’ll see how they recover.

“I think we are in trouble, because in nine years we’ve never been in the situation with so many injuries.

“The players make a step forward, more together than ever, and we will try to do this week in this short time of recovery.”

Guardiola has already lost defensive midfielder and recent Ballon d’Or winner Rodri for the season after he ruptured his ACL against Arsenal in September.

City skipper Kyle Walker and Kevin De Bruyne are out with knee and thigh injuries respectively, with no return date.

Young forward Oscar Bobb fractured his leg in pre-season and is still out, while attacking duo Jeremy Doku and Jack Grealish have been sidelined for City’s recent games.

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In worrying news, Guardiola does not anticipate having Doku back in action until after the November international break.

It’s why the Spaniard needs his medical staff to work miracles if City are to secure a fifth-straight Premier League crown.

“If these guys don’t come back as quickly as possible, we’ll struggle, because we cannot sustain with just 14, 15 players for the season,” Guardiola said.

“We need the players to come back.”

With the lengthy list of absentees, Guardiola’s staggering claim of having just 13 fit outfield players is held up when one takes a look at their first-team squad.

Erling Haaland, who was an unused substitute against Tottenham, is the only available striker.

Phil Foden, Ilkay Gundogan, Mateo Kovacic, James McAtee, Matheus Nunes and Bernardo Silva are the fit midfielders.

As for the defenders, Guardiola has Dias, Nathan Ake, Josko Gvardiol, Rico Lewis, John Stones and Josh Wilson-Esbrand are available.

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Guardiola turned to a number of youth players against Tottenham, including midfielders Nico O’Reilly and Jacob Wright as well as defender Jahmai Simpson-Pusey.

However, should City’s injury crisis continue, more of the club’s most promising academy stars could find themselves thrust into the first-team spotlight sooner than later.