Objectives: The National Alert System for Critical Antimicrobial Resistances (CARAlert) was established in March 2016 as part of the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System, managed by the AURA National Coordination Unit. The objective of CARAlert is to provide timely communication on critical antimicrobial resistances (CARs) to state and territory health departments to inform appropriate response strategies.
Methods: CARAlert uses existing testing and confirmation systems to capture data on CARs. Laboratories confirming CARs enter data into the CARAlert database at the time of confirmation. Nominated state and territory health personnel have restricted access to the system and weekly summaries are distributed to them, the Australian Commission on Safety and Quality in Health Care and the Australian Government Department of Health.
Results: From March 2016 to March 2018, over 2,500 CARs have been confirmed. Nationally, carbapenemase-producing Enterobacteriaceae (CPE), either alone or in combination with ribosomal methyltransferases, and azithromycin non-susceptible Neisseria gonorrhoeae (ANSNG) were the most frequently reported CARs.
The IMP type CPE, found most often in the E. cloacae complex, was the most frequently reported CPE. An outbreak of OXA-48 producing E. coli ST38 was reported in Queensland between May 2017 and July 2017. A small cluster of IMP-producing Enterobacteriaceae was confirmed among six neonates in New South Wales.
ANSNG was the most frequently reported CAR from December 2016 to November 2017. Over the six months to March 2018 there was a decline in reports of ANSNG with low-level resistance (MIC < 256 mg/L). An increasing number of ANSNG with high-level azithromycin resistance (MIC > 256 mg/L), and the confirmation of two isolates with both ceftriaxone non-susceptibility and high-level azithromycin resistance is concerning.
There was a peak in reports of multidrug-resistant Shigella species in December 2017 and January 2018.
Conclusions: In its second year of operation CARAlert is providing regular and timely antimicrobial resistance data to states and territories and nationally.