National Alert System for Critical Antimicrobial Resistances (CARAlert)


The National Alert System for Critical Antimicrobial Resistances (CARAlert) collects data on nationally agreed priority organisms with critical resistance to last-line antimicrobial agents to provide timely information and advice to support clinicians, policy makers and systems managers in regard to antimicrobial resistance in Australia.

About CARAlert

CARAlert was established by the Commission in 2016, as part of the AURA Surveillance System, to collect and report 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 these critical resistances in Australia helps to inform actions that prevent and contain resistance. The system also provides access to confirmatory results directly to state and territory public health services.

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

Species Critical resistance (as at August 2020)
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 non-susceptible or azithromycin non-susceptible
Salmonella species Ceftriaxone non-susceptible
Shigella species Multidrug resistant
Staphylococcus aureus complex* Vancomycin, linezolid or daptomycin non-susceptible
Streptococcus pyogenes Penicillin reduced susceptibility
Pseudomonas aeruginosa Carbapenemase producing
* For CARAlert, S. aureus complex includes S. argenteus and S. schweitzeri

Since its inception, over 8,500 CARs have been reported through the CARAlert system. Through this reporting, a number of CAR outbreaks and periodic increases have been identified including:

  • An outbreak of OXA-48 producing Escherichia coli ST38 in Queensland – 80 cases were reported between May 2017 and July 2017
  • A cluster of IMP-producing Enterobacterales in one institution in New South Wales – detected in the 0-4 year age group between late December 2017 and January 2018
  • A three-fold increase in NDM-type CPE from South Australia in 2019 compared to 2018
  • An increase in NDM- and IMP-type CPE in New South Wales and Victoria in 2019 compared to 2018
  • An increase in reports of multidrug-resistant Shigella species in 2019 compared to 2018, with sharp increases in Queensland (up 261%), Victoria (up 246%) and New South Wales (up 142%).

All of these have been responded to locally by the relevant hospital and/or state or territory health authority.

CARAlert reports and resources