Ana Cristina Gales, Ronan Adler Tavella, Alex Yuri Sato, Juliana Silva Corrêa, João Pedro Rueda Furlan, Ana Paula Cury, Rodrigo Cayô da Silva, César Rossas Mota, Moacir de Miranda Oliveira Junior, Nilton Lincopan, Sérgio Schenkman, André Luiz de Abreu, Renata Tigulini de Souza, Débora Kulek, Carmem Lúcia Pessoa-Silva, Arnaldo L Colombo, AMR-Environmental Working Group
The environmental spread of antimicrobial resistance (AMR) through hospital wastewater (HWW) remains insufficiently addressed in Brazil's national AMR control strategies. This commentary synthesizes recommendations from a multi-institutional technical workshop held in Brazil in June 2025 to support the integration of hospital wastewater surveillance and treatment (HWWST) into the renewed Brazilian National Action Plan on AMR (PAN-BR). Representatives from government, international organizations, and academia identified the absence of a standardized national HWW surveillance framework, limited treatment requirements, fragmented governance, and insufficient mechanisms to translate innovation into implementation. Immediate priorities include developing and piloting a tiered surveillance protocol, selecting representative public and private hospitals for treatment pilots, establishing formal multisectoral coordination, engaging industry and sanitation stakeholders, and defining financing, innovation, and intellectual property pathways for scale-up. Integrating HWWST into the renewed PAN-BR would strengthen Brazil's One Health response and support its G20 and United Nations commitments.