National report on critical antimicrobial resistance highlights prevalence of CPE bacteria in hospitals and novel resistance in N. gonorrhoeae infections

Carbapenemase-producing enterobacteriaceae (also known as CPE) and Neisseria gonorrhoeae continue to be the most commonly reported organisms with critical resistances to antimicrobials across Australia, according to a national report released today.

The latest six-monthly report for the National Alert System for Critical Antimicrobial Resistance (CARAlert) system, released by the Australian Commission on Safety and Quality in Health Care (the Commission), highlights the continuing threat of antimicrobial resistance by dangerous bacteria.

“Knowing which new bacteria are emerging as potential threats allows us to take the initiative in the fight against antimicrobial resistance,” said the Commission’s Senior Medical Advisor for the AURA Surveillance System, Professor John Turnidge.

“The finding that CPE remains prevalent in Australian hospitals is concerning. This group of bacteria has the ability to cause common infections, has limited treatment options, and can have a death rate as high as 50% for blood stream infections.”

“These bacteria do not discriminate. The latest report shows that few age groups are spared, including our youngest Australians, children aged up to four years.

“As CPE are becoming commonplace across various hospital settings in Australia, clinicians need to be aware of the patient populations at risk to limit spread to other patients. Should infection occur, they should seek specialist advice to deliver appropriate treatments.”

The continued volume of CPE reports (255 in the six months to 31 March 2018) highlights the importance of effective infection prevention and control to help combat the threat of antimicrobial resistance.

The Commission has published guidelines to help acute health facilities control the further spread of this infection and has strengthened efforts to improve and reduce antimicrobial use, for example through antimicrobial stewardship programs in healthcare settings.

Outside of the hospital environment, another key finding of the latest CARAlert report relates to the continued high number of alerts for resistance in N. gonorrhoeae, a bacterial sexually transmitted infection.

For the first time, two extensively drug resistant (XDR) N. gonorrhoeae infections have been reported in Australia, following a report in the United Kingdom of a similar strain. These infections are unable to be treated with the recommended treatments of ceftriaxone and azithromycin. A further five strains have high-level azithromycin resistance alone.

The detection of these strains is concerning because of the potential for N. gonorrhoea to cause a community outbreak of sexually transmitted infections. While reports of low-level resistance to azithromycin in N. gonorrhoeae have decreased by 26% since the last six-monthly report, they still account for more than one third (38%) of all CARAlerts.

“To prevent sexually transmitted infections (STIs), either to yourself or others, it is best to practice safe sex. Safe sex includes using a condom or dental dam to ensure that you do not pass an infection on to your partner,” said Professor Turnidge.

The report also indicates an increase in the multi-drug resistant Shigella species – an infection associated with food-borne illness, particularly in people returning from overseas travel in developing countries.

“Clinicians in the community should be aware of risk factors for highly resistant community infections including overseas travel,” Professor Turnidge added.

The CARAlert system was established by the Commission in 2016 to monitor and report on cases of bacteria resistant to critically important antimicrobials which are considered to be a serious threat to the effectiveness of last-line antimicrobial agents.

In total, 653 CARs were reported by 58 participating laboratories between October 2017 and 31 March 2018, a number similar to the same period in the previous year (October 2016 to March 2017). Forty-eight percent of CARs were detected from patients attending hospitals.

At least one strain of bacteria with some type of critical antimicrobial resistance was reported from each state and territory, with the three most populous states accounting for 87% of all CARs: New South Wales (32%), Victoria (34%) and Queensland (21%). The lowest numbers of CARs were reported from Tasmania (5), the Northern Territory (4) and South Australia (1).

“The Commission is collaborating with states and territories to establish a network to coordinate responses to outbreaks of resistant organisms in Australia. The timely data that CARAlert provides is a key resource to inform these responses,” said Professor Turnidge.

This report is available on the Commission’s website (…). It complements a number of CARAlert updates and reports also available on the Commission’s website.


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About the Commission

The Australian Commission on Safety and Quality in Health Care is an Australian Government agency that leads and coordinates national improvements in the safety and quality of health care based on the best available evidence. By working in partnership with the Australian Government, states and territories, the private sector, clinical experts, and patients and carers, the Commission aims to ensure that the health system is better informed, supported and organised to deliver safe and high-quality care.


AURA Surveillance System

The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System enables collection and analysis of data to provide reports to inform clinical policy and practice. The AURA National Coordination Unit (NCU) at the Commission works with a range of stakeholders to inform action at the local, state and territory, and national levels to prevent and contain the spread of antimicrobial resistance. CARAlert is a core component of AURA.

AURA is funded by the Commonwealth Department of Health and the Commission.


The National Neisseria Network

The National Neisseria Network (NNN) was established in 1981. It is supported by the Commonwealth Department of Health to provide the Australian Gonococcal Surveillance Programme. Private and public laboratories throughout Australia refer isolates to the NNN Reference Laboratories for testing for antimicrobial susceptibility.