Microbial resistance represents a growing threat to public health, intensified by the use of antimicrobials. Adherence to antimicrobial management programs is still limited in many Brazilian hospitals. The objective was to compare hospitals that implemented such programs with those that have not yet adopted this strategy.

A cross-sectional, retrospective, and multicenter study was conducted in Brazilian hospitals with adult intensive care units, included by non-probabilistic and convenience sampling. Data collection was carried out through a self-administered electronic questionnaire composed of 94 items (2024–2025). Institutional characteristics and compliance with the six essential components of antimicrobial management programs were evaluated. The units were grouped according to hospital profile and categorized into four levels of implementation.

A total of 1,453 hospitals from all federative units participated, of which 766 (52.7%) reported having the antimicrobial management program implemented. The hospital infection control committee was present in 99.8% and 97.8% of hospitals with and without the program, respectively. Regarding laboratory/microbiological capacity, the frequency of outsourced laboratories did not vary, remaining around 30.0%. Most programs were implemented from 2020 onwards, with higher frequency in 2024 (28.5%). Among the difficulties reported for program execution were high staff turnover, disorganization of processes, and low team engagement. In hospitals without the program, the main obstacles mentioned were the absence of qualified professionals, limited institutional support, and insufficient resources. Despite this, 100% of the institutions stated that they develop at least one action aimed at the use of antimicrobials.

Hospitals with an antimicrobial management program implemented showed greater maturity in clinical governance. On the other hand, hospitals without the program showed operational and structural limitations that weaken the overall implementation of measures. The findings reinforce the need for coordinated national strategies and institutional technical support to expand adherence and strengthen the capacity of Brazilian health services in addressing microbial resistance and all related impacts.