OCTOBER 2025
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By Dr. Viviana E. Rodriguez*
Bacterial resistance to antimicrobials (AMR) constitutes a priority threat to public health, driven by the inappropriate use of antimicrobials en Human health, animal health, farming and its dissemination in the environment. In 2019 were estimated 4,95 million related deaths with multi-resistant bacteria, of which 1,27 million were directly attributable to the RAM. In Latin America and the Caribbean, were calculated 338.000 related deaths y 84.300 attributable to RAM for that same year. Beyond the health impact, it is projected that the economic losses associated with this problem will reach $100 billion by 2050This scenario demands comprehensive policies that optimize antimicrobial use, strengthen infection control, and develop local research and implementation capacities, with special attention to resource-limited settings.
World AMR Awareness Week, which will take place from 18 to 24 November at the initiative of the World Health Organization (WHO), represents an opportunity to reflect on the direct and indirect harms of inappropriate antimicrobial use. In hospitalized patients, a considerable proportion of those receiving antimicrobials experience at least one adverse event, and between 20 and 40% of these events are linked to prescriptions without a robust clinical indication. At the service level, higher prescribing intensity is associated with increases in Clostridioides difficult and other related complications. In intensive care units (ICUs), where patients with more severe illness, exposure to invasive devices, and prolonged empirical treatment courses converge, the prevalence of infection and its adverse outcomes are particularly high.
International literature consistently shows that Antimicrobial Use Optimization Programs (AOPs) improve the adequacy of prescriptions, reduce unnecessary consumption and decrease the incidence of It's hard and colonization or infection by resistant bacteria, without affecting mortality. Systematic reviews and meta-analyses have documented favorable clinical and economic effects, with net savings derived from lower pharmaceutical expenditures and fewer complications. Before-and-after experiences in ICUs corroborate substantial improvements when clinical leadership and a set of combined strategies (education, audit with feedback, prospective review, and restriction of certain drugs) are in place. However, these programs require context-sensitive implementation approaches, tailored to local capacities and organizational culture.
There are examples of successful initiatives in Argentina. In 2022, in collaboration with the Argentine Societies of Infectious Diseases (SADI) and Intensive Care (SATI), our IECS team conducted a multicenter study in eight ICUs across the country to implement a Quality Improvement Collaborative aimed at optimizing antimicrobial use in high-pressure settings due to resistant gram-negative bacteria. The study showed a reduction in defined daily doses of antimicrobials and improvements in the scores of infection prevention and control programs evaluated according to the WHO tool.
From a health economics perspective, reports suggest that modest but sustained investments in stewardship programs, combined with infection control and vaccination, are cost-effective in the medium term, with positive returns for both public and private systems.
AMR will continue to strain Latin American health systems unless policies and capacities are consolidated to promote prudent and timely use of antimicrobials. Available evidence—from international meta-analyses to local qualitative studies—supports that APRs associated with infection prevention and control programs, when supported by clinical leadership, meaningful measurement, and organizational learning mechanisms, constitute an effective and sustainable response. In a context of limited resources, prioritizing therapeutic appropriateness and institutionalizing collaborative practices appear to be necessary conditions for transforming knowledge into clinical outcomes while simultaneously protecting the future effectiveness of antimicrobials.
*Coordinator of the Department of Quality, Patient Safety and Clinical Management of the IECS.