National Alert System for Critical Antimicrobial Resistances (CARAlert)

CARAlert collects data on nationally agreed priority organisms with critical resistances to last-line antimicrobial agents. CARAlert provides timely information and advice to support clinicians, policy makers and system managers respond to antimicrobial resistance (AMR) in Australia.

Background

CARAlert is part of the AURA Surveillance System. It collects and reports on data on critical antimicrobial resistances (CARs) – these are resistance mechanisms or profiles that are known to present a serious threat to the effectiveness of last-line antimicrobial agents.

Monitoring and providing regular reports on CARs in Australia helps to inform actions that prevent and control AMR. CARAlert also provides state and territory public health services with access to confirmed CAR results.

The CARs that are reported to CARAlert are outlined in the table below.

Species	Critical resistance
Acinetobacter baumannii complex	Carbapenemase-producing
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, S. aureus complex includes S. argenteus and S. schweitzeri}

In 2022, the Commission conducted a review of CARAlert to assess whether currently reported CARs continue to be priorities, and to identify any additional CARs for inclusion.

Following consultation with states, territories and a range of clinical experts, from 1 January 2023:

Ciprofloxacin-nonsusceptible N. meningitidis was added to CARAlert
Gentamicin-resistant N. gonorrhoeae was added to CARAlert
Reporting of daptomycin-nonsusceptible S. aureus was suspended and will be considered for reintroduction when more reliable phenotypic testing methods are available.