A recent mixed-method study from CAMO-Net Brazil has provided valuable insights into the barriers and enablers of implementing antimicrobial stewardship (AMS) in primary healthcare settings in São Caetano do Sul, Brazil.
The study, published in the American Journal of Infection Control, was conducted between August and December 2023, combined quantitative data from 208 healthcare workers and qualitative interviews with 16 patients and 12 healthcare workers. The aim was to understand the local context of antimicrobial use and inform the development of targeted AMS strategies.
Led by Dr Letícia Britto Costa from the Institute of Tropical Medicine, University of São Paulo, where CAMO-Net Brazil is located, the study revealed that professionals with higher education, such as physicians, nurses, and pharmacists, demonstrated higher confidence and knowledge in antimicrobial use. However, healthcare workers with intermediate educational backgrounds, such as community health agents and nurse technicians, reported limited training and felt uncertain about their roles in AMS.
A significant finding was the physician-centred decision-making process, which often excluded other healthcare workers from contributing to antimicrobial management. This led to frustration and anxiety among non-prescribing professionals, who felt ill-equipped to support patients with complex infections.
The study also highlighted critical breaks in the continuity of care, with patients frequently navigating between multiple health services without adequate follow-up. Additionally, patients demonstrated limited understanding of antibiotics, with some confusing them with painkillers or self-medicating inappropriately.
Building on CAMO-Net Brazil’s work
This research builds on CAMO-Net Brazil’s ongoing efforts to enhance antimicrobial stewardship. Notably, it complements the recent launch of guidelines on antimicrobial use in São Caetano do Sul, which aim to standardise prescribing practices and support healthcare workers in optimising antimicrobial use.
Recommendations for AMS implementation
Dr Letícia Britto Costa emphasised the importance of addressing these gaps through targeted educational programmes. “To successfully implement antimicrobial stewardship, we must invest in comprehensive training for all healthcare workers and establish clear guidelines for antimicrobial use, such as those recently published by CAMO-Net Brazil. By empowering our teams and engaging patients and caregivers, we can optimise antimicrobial use and reduce the burden of resistance.”
The study recommends:
- Tailored training sessions for all healthcare worker categories, focusing on infection management and communication with patients.
- Development of local guidelines for antimicrobial prescribing.
- Improved coordination between health services to enhance continuity of care.
- Educational campaigns for patients and caregivers on the appropriate use of antibiotics.
This study highlights the need for a multifaceted approach to AMS in Brazil’s primary healthcare settings. By leveraging healthcare workers’ willingness to learn and addressing training disparities, the CAMO-Net Brazil team aims to bridge the gap between scientific evidence and clinical practice. These efforts are essential for addressing antimicrobial resistance and safeguarding public health, not only in Brazil but also as a model for strengthening stewardship in primary healthcare settings worldwide.
