Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

Abstract

Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review the situation with respect to AMR in Brazil and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Brazil and to improve patient outcomes. Methods National initiatives to address AMR, antibiotic use and prescribing in Brazil, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infections (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, along with local antibiotic availability. Conclusions In Brazil there have been some initiatives addressing AMR such as the National Action Plan for AMR, established in 2018. Antibiotic consumption in Brazil is high but a ban on over-the-counter sales of antibiotics has led to a decrease in consumption. Local antibiotic susceptibility testing needs to be increased and the Survey of Antibiotic Resistance (SOAR) study in Brazil will provide useful data for pathogens causing CA-RTIs. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Brazil, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.

Biodiversity of carbapenem-resistant bacteria in clinical samples from the Southwest Amazon region (Rondônia/Brazil)

“…When observing other Brazilian states, including Rondônia, the results are the same in terms of the number of species, only varying in the percentage of resistance. Only in 2018 did Brazil present the PAN-BR (2018–2022), which is aligned with the five strategic objectives of the Global Action Plan, which is now part of the One Health approach that includes several government bodies; however, there is no national data on microbial resistance, and the inefficiency or lack of infection prevention and control programs was mentioned in the presentation 20 .…”

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

“…In cooperation with the National Health Surveillance Agency (ANVISA—Portuguese acronym) and the Pan America Health Organization, the Brazilian Ministry of Health has made efforts to detect and control AMR since 2005 by establishing the AMR Network [ 15 ]. In 2015 for AMR Net, ANVISA chose 4 RRLs in 4 Brazilian states (Paraná, São Paulo, Brasília, Piauí) and 1 NRL (LAPIH- Fundação Oswaldo Cruz Rio de Janeiro) to provide AMR referral testing in healthcare services [ 16 ].…”

“…In 2015 for AMR Net, ANVISA chose 4 RRLs in 4 Brazilian states (Paraná, São Paulo, Brasília, Piauí) and 1 NRL (LAPIH- Fundação Oswaldo Cruz Rio de Janeiro) to provide AMR referral testing in healthcare services [ 16 ]. In 2018, Brazil started participating in the World Health Organization–Global Antimicrobial Resistance Surveillance System (GLASS) and published its National Acting Plan on AMR, which established the need to create a national surveillance program on AMR (BR-GLASS) [ 15 , 17–19 ]. By 2020, the BR-GLASS database contained more than 30 000 isolates.…”