Antimicrobial Use and Resistance in Australia (AURA)
The Commission’s AURA Project contributes to the national surveillance program for antimicrobial use and resistance in human health.
What is antimicrobial resistance?
Antimicrobials is the term used to refer to all antibiotics, antivirals, antifungals, and antiparasitic agents. They are each important medicines that treat and prevent infections caused by microorganisms, including bacteria, viruses, fungi and parasites.
Antimicrobial resistance (AMR) is the failure of an antimicrobial to effectively treat or prevent an infection that it was previously able to. This means that a microorganism has developed resistance to an antimicrobial. AMR affects all antimicrobials, not just antibiotics.
A microorganism can be resistant to many antimicrobials. This is called multi-drug resistance. This is a risk to patient safety as it reduces the range of antimicrobials available to successfully treat infections.
AMR can impact people at all ages and also poses a threat to veterinary, agriculture and environmental industries. This makes AMR one of the most urgent public health issues globally.
What causes antimicrobial resistance?
AMR occurs naturally when microorganisms change to protect themselves from being injured or killed by antimicrobials. The more antimicrobials are used, the more likely it is AMR will develop. Increasing AMR is also driven by the spread of microorganisms and their resistance mechanisms.
Many infections get better without antimicrobials. Taking an antimicrobial inappropriately, that is when it is not needed or for longer than required, can cause microorganisms to develop resistance.
Antimicrobial-resistant microorganisms can spread from person-to-person, meaning people can be affected by AMR even without taking antimicrobials. If these resistant microorganisms later cause infections that need to be treated, the antimicrobial will be ineffective.
AURA surveillance
The AURA surveillance program is funded and coordinated by the Australian Centre for Disease Control (CDC). It was established by the Commission in 2014, with funding previously provided by the Australian Government Department of Health, Disability and Ageing.
It supports Australia’s efforts to prevent and contain AMR in human health, and implementation of Australia’s National AMR Strategy - 2020 and Beyond.
Hundreds of people in Australia die each year as a result of AMR. Effective surveillance and monitoring of antimicrobial use and resistance are essential to determine the burden of AMR and risk to patient safety. Findings inform strategies and priorities for antimicrobial stewardship (AMS) and infection prevention and control programs, prescribing guidelines and information for clinicians and consumers about safe and appropriate use of antimicrobials.
The Commission’s AURA Project coordinates elements of the AURA surveillance program, including:
- Australian Passive AMR Surveillance (APAS) that collects, analyses and reports on patient-level AMR data from routine susceptibility testing results
- National Alert System for Critical Antimicrobial Resistances (CARAlert) that collects, analyses and reports on priority organisms with critical resistances to last-line antimicrobials
- Reporting on community antimicrobial use.
Subscribe for the latest updates on antimicrobial resistance and infection prevention and control.
For consumer information about AURA and AMR, please visit our site for consumers.
AURA Data Explorers
We have developed two interactive, publicly accessible, data visualisation dashboards for national AMR data.
APAS Data Explorer
The APAS Data Explorer provides dynamic, map-based visualisations of 2020 to 2024 data on:
- Ciprofloxacin resistance in Escherichia coli from urinary tract infections
- Ceftriaxone/cefotaxime resistance in E. coli and Klebsiella pneumoniae
- Vancomycin resistance in Enterococcus faecium
- Methicillin resistance in Staphylococcus aureus.
CARAlert Data Explorer
The CARAlert Data Explorer for critical antimicrobial resistances (CARs) allows trend tracking by year, state and territory, specimen type and resistance.
National AURA Reports
National AURA reports provide comprehensive data analyses on patterns and trends in antimicrobial use and appropriateness and AMR in Australian acute and community healthcare settings from data sources across the AURA surveillance program. These reports also identify priority areas for action for patient safety and delivery of care.
The Australian Centre for Disease Control (CDC) released the Sixth Australian report on antimicrobial use and resistance in human health in February 2026. This report builds on the first five national AURA reports developed by the Commission.
Antimicrobial use
The more widely antimicrobials are used, the more likely it is that microorganisms will develop resistance and risk antimicrobials becoming ineffective. Antimicrobial use also contributes to healthcare-associated impacts on the environment.
Community antimicrobial use
The majority of antimicrobial use in Australia occurs in the community, that is in general and specialist practice, community health services, aged care homes and other non-hospital settings.
The latest reports on antimicrobial use and appropriateness in the community were released in August and December 2025. These reports include analyses of antimicrobials supplied under the PBS/RPBS from 2015 to 2024 and highlights aged care and local area data, and analyses of antibacterials prescribed in MedicineInsight general practices from 2015 to 2024, respectively.
There are limited data available on the indications for which antimicrobials are prescribed, and for private prescriptions as they are not subsidised by the PBS/RPBS. This is an important gap in the surveillance of antimicrobial use and appropriateness in Australia.
Please contact us if you would like to access previous reports.
Hospital and aged care antimicrobial use
Data on antimicrobial use in Australian hospitals are collected by the National Antimicrobial Prescribing Survey (NAPS) and the National Antimicrobial Utilisation Surveillance Program (NAUSP). NAPS also collects data on antimicrobial use and infections in aged care homes.
Information about NAPS modules and reports are available on the NAPS website.
Information about NAUSP and reports are available on the NAUSP website.
Antimicrobial resistance
Antimicrobial-resistant microorganisms and the resistance genes they carry, can spread readily between people in the community as well as those receiving care in health services across settings.
National data on AMR in hospitals and the community (in general practice, community health services, aged care homes and other non-hospital settings) are collected via:
- Australian Group on Antimicrobial Resistance (AGAR)
- Australian Passive AMR Surveillance (APAS)
- National Alert System for Critical Antimicrobial Resistances (CARAlert).
Australian Group on Antimicrobial Resistance (AGAR)
The Australian Society for Antimicrobials (ASA) coordinates AGAR, which collects, analyses and reports on AMR data on selected priority organisms that cause bloodstream infections: enterococcal species, Staphylococcus aureus and gram-negative bacteria, known as Surveillance Outcome Programs.
The Commission has collaborated with AGAR to prepare annual amalgam reports on the Surveillance Outcome Programs. The last report was released in December 2024 and reveals epidemiologic and genetic patterns in bloodstream infections in Australia.
AGAR continues to publish a range of reports, including individual reports on each Surveillance Outcome Program on its website.
Australian Passive AMR Surveillance (APAS)
APAS was established by the Commission in collaboration with Queensland Health in 2015. It uses the OrgTRx information technology infrastructure to extract de-identified patient-level AMR data from all routine susceptibility testing results from the laboratory information systems of voluntarily participating pathology services across Australia.
APAS holds over 135 million susceptibility results, which show geographical and organism-related trends in AMR in Australia.
Visit the APAS Data Explorer to explore the latest AMR patterns.
APAS reports
The AURA Project publishes data analysis reports on aggregate national APAS data on relevant AMR topics for patient safety or emerging issues. These reports are also complementary to the APAS Data Explorer.
- Australian Passive AMR Surveillance: An update of resistance trends in multidrug-resistant organisms – 2006 to 2023
- Australian Passive AMR Surveillance: Trends in macrolide resistance in Streptococcus agalactiae and Streptococcus pyogenes – 2006 to 2023
- Australian Passive Antimicrobial Resistance Surveillance (APAS) – third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae: prevalence of extended-spectrum β-lactamase (ESBL) phenotype
APAS participants
| State/Territory | Pathology service | Notes |
|---|---|---|
| New South Wales | NSW Health Pathology | All NSW Health Pathology public laboratory services. |
| Victoria | Alfred Health | Public health service catchment for Alfred Health. |
| Monash Health | Public health service catchment for Monash Health. | |
| Queensland | Mater Pathology Queensland | Queensland public and private patients. |
| Pathology Queensland | All Queensland Health public hospitals and health services. | |
| South Australia | SA Pathology | Public health catchments for South Australia. |
| Western Australia | PathWest Laboratory Medicine | All Western Australia public hospitals. |
| Tasmania | Launceston General Hospital | Combined data from these two contributing laboratories capture most public patient data for Tasmania. |
| Royal Hobart Hospital | ||
| Australian Capital Territory | ACT Pathology | All public and some private ACT health services. |
Note: Data are available from the Northern Territory for residents who received pathology services interstate.
Please contact us if your pathology service is interested in participating in APAS.
APAS support resources
The following resources have been developed to provide support to APAS participants.
- Webinar 1 – Introduction to APAS and System Demonstration
- Webinar 2 – APAS – Introduction to APAS System (OrgTRx Platform) for New Users
- Webinar 3 – Advanced system training
- APAS – OrgTRx Module User Guide
- APAS – OrgTRx Standard Operating Procedure - How to use the Statistical Area (SA) Geoanalytics Dashboard in OrgTRx
- APAS - OrgTRx User guide - Dashboard Colour Customisation
- APAS - OrgTRx User Guide - Verification Rules
- APAS – OrgTRx Quick Reference Guide – Creating a formatted cumulative antibiogram
- APAS – OrgTRx Quick Reference Guide – Susceptibility profile for CLSI & EUCAST Methods - June 2020
- APAS – OrgTRx Quick Reference Guide – Susceptibility profile for MRSA, VRE and CROs
- APAS – OrgTRx Quick Reference Guide – Troubleshooting OrgTRx VPN Connections
- APAS – OrgTRx Quick Reference Guide – Remoteness Capability Functionality
- APAS – OrgTRx Quick Reference Guide – Displaying the maximum count
- APAS – OrgTRx Quick Reference Guide – Paediatric antibiogram
- APAS – OrgTRx Quick Reference Guide – Calculating group susceptibility
- APAS – OrgTRx Quick Reference Guide – Adjusting the Y axis scale
- APAS – OrgTRx Quick Reference Guide – Displaying % non-susceptible
- APAS – OrgTRx Quick Reference Guide – Change View Title
- APAS (OrgTRx Platform) Frequently Asked Questions
- APAS Notification to Commission of Upgrade/Change to Site System(s) Form
- APAS (OrgTRx Platform) Proposed Enhancement Request Form
National Alert System for Critical Antimicrobial Resistances (CARAlert)
CARAlert was established by the Commission in 2016. It collects data from voluntarily participating public and private laboratories across Australia to report on seasonal and geographic trends in critical antimicrobial resistances (CARs) – these are critical resistance mechanisms or profiles that are uncommon in Australia and known to be a serious threat to the effectiveness of last-line antimicrobial agents. These data support infection prevention and control responses for potential outbreaks.
Visit the CARAlert Data Explorer to explore trends in CARs across Australia.
CARAlert reports and data updates
Data updates include descriptive information summary only and complement the CARAlert Data Explorer, and CARAlert annual reports that include analysis and commentary on patient safety implications.
- CARAlert data update 42: 1 July to 30 September 2025
- CARAlert data update 41: 1 April to 30 June 2025
- CARAlert data update 40: 1 January to 31 March 2025
- CARAlert Annual Report: 2024
Critical antimicrobial resistances (CARs)
The CARs that are reported to CARAlert are outlined in the table below.
| Species | Critical resistance |
|---|---|
| Acinetobacter baumannii complex* | Carbapenemase-producing |
| Candidozyma (Candida) auris | |
| Enterobacterales | Carbapenemase-producing, and/or ribosomal methyltransferase-producing |
| Transmissible colistin resistance | |
| Enterococcus species | Linezolid-resistant |
| Mycobacterium tuberculosis | Multidrug-resistant – resistant to at least rifampicin and isoniazid |
| Neisseria gonorrhoeae | Ceftriaxone- and/or azithromycin-nonsusceptible |
| Gentamicin-resistant | |
| Neisseria meningitidis | Ciprofloxacin-nonsusceptible |
| Pseudomonas aeruginosa | Carbapenemase-producing |
| Salmonella species | Ceftriaxone-nonsusceptible |
| Shigella species | Multidrug-resistant |
| Staphylococcus aureus complex† | Vancomycin- or linezolid-nonsusceptible |
| Streptococcus pyogenes | Penicillin-reduced susceptibility |
* For CARAlert, A. baumannii complex includes A. baumannii, A. calcoaceticus, A. dijkshoorniae, A. nosocomialis, A. pittii and A. seifertii
† For CARAlert, S. aureus complex includes S. argenteus, S. aureus and S. schweitzeri
CARAlert support resources
The following resources have been developed to provide support for stakeholders that contribute to CARAlert.
- CARAlert Laboratory Handbook
- CARAlert Isolate Referral Form
- CARAlert Standard Operating Procedures
- CARAlert Web Portal: Quick Reference Guide for Laboratory Users
- CARAlert Web Portal: Quick Reference Guide for State and Territory Health Users
For more information or if your laboratory is interested in participating in CARAlert contact CARAlert@safetyandquality.gov.au.
Access previous reports
Please contact us if you would like to access previous reports.