# Fighting antimicrobial resistance in Brazil: strengthening diagnostic stewardship, antimicrobial stewardship, and policies for a healthier future

## TL;DR

Brazil faces a serious antimicrobial resistance crisis, and this paper highlights the need for better diagnostics, stewardship programs, and policies to address it.

## Contribution

The paper provides a critical analysis of AMR challenges in Brazil and proposes strategic recommendations for policy and healthcare system improvements.

## Key findings

- Only 47.5% of surveyed hospitals with ICUs in Brazil had implemented antimicrobial stewardship programs.
- blaNDM carbapenemases are on the rise, highlighting the need for improved surveillance and diagnostics.
- Investments in diagnostic technologies and regional collaborations are crucial for combating AMR.

## Abstract

Antimicrobial resistance (AMR) constitutes a growing public health crisis in Latin America, with Brazil facing particularly severe challenges. The drivers are multifaceted, prominently including suboptimal antimicrobial prescribing practices. Limited access to quality diagnostics and weak implementation of DS and AMS programmes further impede timely antimicrobial de-escalation and worsen the problem. National surveys confirm this gap; one 2019 survey of 954 hospitals with ICUs found that only 47.5% had implemented an ASP. This review critically examines the current landscape of AMR in Brazil, analyzing policy gaps and implementation challenges across primary, secondary, and tertiary healthcare sectors within the public, supplementary, and private healthcare systems. Key findings underscore the imperative to enhance diagnostic stewardship for optimizing antimicrobial selection, bolster surveillance systems, which now reveal a concerning rise in blaNDM carbapenemases, and reinforce AMS programs across all healthcare settings. Strategic recommendations emphasize crucial investments in laboratory infrastructure and rapid diagnostic technologies, the adoption of value-based healthcare policies to overcome reimbursement barriers, and to incentivize quality outcomes over quantity, and the cultivation of robust regional and international collaborations to AMR effectively. Finally, it recommends the implementation of a National Policy Statement, as well as a National Program on Antimicrobial Resistance Prevention and Control.

Illustrations are original works created by MIND (https://www.mind.net.br/).Illustration depicting efforts to combat antimicrobial resistance in Brazil. Central figures include healthcare professionals with medical equipment. Arrows connect diagnostic stewardship, antimicrobial stewardship, the Stewardship Brasil logo, and the PAN-BR policy booklet. Icons at the bottom represent antimicrobial resistance, clinical outcomes, and healthcare resources.

Illustrations are original works created by MIND (https://www.mind.net.br/).