National Alert System for Critical Antimicrobial Resistances (CARAlert)

AURA

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.

About CARAlert

CARAlert was established by the Commission in 2016, with funding from the Department of Health and Aged Care. 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- or azithromycin-nonsusceptible
  Gentamicin-resistant
Neisseria meningiditis Ciprofloxacin-nonsusceptible
Salmonella species Ceftriaxone-nonsusceptible
Shigella species Multidrug-resistant
Staphylococcus aureus complex* Vancomycin- or linezolid-nonsusceptible
Streptococcus pyogenes Penicillin-reduced susceptibility
Pseudomonas aeruginosa Carbapenemase-producing

* 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. meningiditis 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.

CARAlert reports and resources