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

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 bla NDM 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.