DOI: 10.3310/nihropenres.14297.2 ISSN: 2633-4402

Factors associated with inequalities in antimicrobial-resistant bloodstream infections among socioeconomically disadvantaged populations in high-income countries: a systematic review protocol

Diane Ashiru-Oredope, Shannon Guild, Caroline De Brún, Jack Duxbury Barber, Rhys Kingston, Jocelyn Elmes, Sarah Gerver, Matthew Inada-Kim, Colin Brown, Russell Hope,
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Introduction Emerging evidence suggests that the burden of antimicrobial resistant (AMR) bloodstream infections (BSI) disproportionately affects populations with factors commonly associated with health inequalities, including high deprivation levels and ethnic minority groups. The aim of this review is to identify and synthesise factors associated with inequalities in AMR BSI and related outcomes among socioeconomically disadvantaged populations in high-income countries (HICs). Methods and analysis This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and standards of the reporting equity-focused systematic reviews (PRISMA-E) guidelines. It is informed by the Cochrane methodology for prognosis and equity. We will search five electronic databases (Ovid Embase, Ovid MEDLINE, CINAHL, Scopus, Cochrane Central Register of Controlled Trials) using tailored search terms. Grey literature sources will also be screened. Peer-reviewed observational, intervention and mixed methods studies will be eligible if they report a) quantitative data on AMR BSI and b) factors associated with reported health disparities (e.g. deprivation score; education; ethnicity) in socioeconomically disadvantaged populations from Organisation for Economic Co-operation and Development member countries. No language or publication date limits will be applied. A team of reviewers will complete screening of allocated abstracts and titles for eligibility and a large language model will conduct a secondary screening. Full-text screening, data extraction and risk-of-bias assessment will be undertaken by trained members of the review team following predefined quality assurance procedures and validation exercises. A narrative synthesis will summarise findings, with meta-analysis conducted only where sufficient methodological and clinical homogeneity exist. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024601049 ). Ethics and dissemination We will identify factors associated with disparities in AMR BSI and use these findings to inform further modelling work, guide clinical practice, and support targeted public health interventions within HICs.

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