Stewardship in Brazil: A Call for Action

To the Editor—After reviewing Fabre et al's [1] outstanding study, we understand the need to present Brazil's national survey results on antimicrobial stewardship programs (ASPs). This is particularly crucial in the postpandemic context of Brazil, which is Latin America’s (LATAM’s) most populous country. In this brief report, we aimed to provide a broader LATAM perspective by addressing the limitations of Fabre et al, which excluded Brazil and the impact of the pandemic on ASPs. A recent study revealed a sharp increase in inappropriate antimicrobial prescriptions among adults before and during the coronavirus disease 2019 (COVID-19) pandemic in Brazil [2]. Brazil has the highest number of COVID-19 cases and the second highest mortality rate in LATAM, raising concerns about antimicrobial misuse and Antimicrobial Resistance (AMR) [2]. The Antimicrobial Stewardship Brazil Group (ASP-BR) conducted 2 surveys to understand the factors influencing the implementation and extent of implementation in Brazil before and after the pandemic. The ASP-BR includes the Brazilian Health Surveillance Agency, Brazil's Ministry of Health, Santa Cruz do Sul University, and the Brazilian Association of Professionals in Infection Control and Hospital Epidemiology. The first survey was conducted between July and August 2019 after publishing the initial Brazilian Guidelines for Antimicrobial Management Programs [3]. The first survey [4] evaluated ASPs in adult intensive care unit (ICU) hospitals before the pandemic. The second survey (October 2022–January 2023) [5] assessed ASPs in all healthcare institutions that responded to the survey after publication of the new guidelines [6].