What is CARAlert and why do we need it?
CARAlert stands for Critical Antimicrobial Resistance Alert; a national initiative involving 73 pathology laboratories across Australia, to report the detection of bacteria resistant to last-line antibiotics.
CARAlert is the first nationally coordinated system for communicating data on confirmed cases of dangerous resistant bacteria (CARs) and potential CAR outbreaks as close as possible to the time of confirmation.
Antimicrobial resistance is one of the biggest threats to human health the world is facing over the next decade. Having as much information as possible about resistant bacteria helps to guide scientists and policy-makers in combating antibiotic resistance in Australia.
This national effort provides timely advice to state and territory health authorities on the occurrence of CARs in their hospitals and nationally.
What is being reported?
The data reported does not identify individual patients but does capture if the patient was in the community or admitted to the hospital at the time of testing.
Pathology teams report on bacteria known to be resistant to last-line antibiotics, these are:
| Bacteria Species | Critical Resistance |
| Enterobacteriaceae | Carbapenemase-producing strains, or Ribosomal methylase-producing strains |
| Enterococcus species | Linezolid non-susceptible |
| Mycobacterium tuberculosis | Multi-Drug Resistant (MDR) – at least rifampicin plus isoniazid resistant-strains |
| Neisseria gonorrhoeae | Ceftriaxone non-susceptible or azithromycin non-susceptible strains |
| Salmonella species | Ceftriaxone non-susceptible strains |
| Shigella species | MDR strains |
| Staphylococcus aureus | Vancomycin, linezolid or daptomycin non-susceptible |
| Streptococcus pyogenes | Penicillin reduced susceptibility |
What has been found so far?
The CARAlert system has been operating since March 2016. During the first 12 months 1,064 CARs were entered into the database[1], an average of 86 entries per month.
Between March 2016 and November 2016, the most common bacteria reported was Carbapenemase-resistant Enterobacteriaceae (CPE), either alone or in combination with ribosomal methyltransferases (RMT). From December 2016, azithromycin non-susceptible Neisseria gonorrhoeae were most frequently reported, and in March 2017 contributed to 62% of all CARs reported.
What does this mean for patients?
The CPE superbug is of concern and requires rigorous infection control measures within health and care settings, including medical facilities and aged care homes where some bugs have been found to flourish[2].
Community awareness is also vital regarding the large number of antibiotic-resistant Neisseria gonorrhoeae cases. As these bacteria are sexually transmitted, the spread can be limited by safe sexual practices. Potential complications related to untreated gonorrhoea infection include Pelvic Inflammatory Disease in women and rarely the development of meningitis.
A/Prof Rob Baird is a microbiologist and an ambassador for Pathology Awareness Australia, he said; “The CARAlert system is an excellent way to track resistant bacteria in close to real time around the country. Over time the data will show any seasonal or geographical trends and right now it allows health services to act quickly on infection control.”
[1] https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/what-is-aura/national-alert-system-for-critical-antimicrobial-resistances-caralert/
[2] http://www.abc.net.au/news/2017-07-19/superbug-report-reveals-rise-in-antibiotic-resistance-gonorrhoea/8720598
