Low-cost approaches for detecting antimicrobial resistance in bacterial infections in resource-limited settings: a...

Antimicrobial resistance (AMR) poses a growing global threat, with low- and middle-income countries (LMICs) bearing a disproportionate burden of resistant infections. Detection of resistance is critical for guiding treatment, enabling stewardship, and supporting surveillance, yet diagnostic capacity in LMICs remains severely limited. We conducted a scoping review to map low-cost diagnostic approaches suitable for resource-limited settings for detecting AMR in bacterial infections, excluding tuberculosis. Following PRISMA-ScR guidelines, we screened 585 articles and included 61 studies, which we evaluated using a framework based on the WHO REASSURED criteria. Genotypic approaches predominated (39 studies) while 22 studies employed phenotypic approaches. The majority (72%) were proof-of-concept studies, only 8 were implemented in LMICs, and just 2 assessed clinical outcomes. Critical gaps included limited validation on clinical specimens, near-absent cost data, high infrastructural requirements, and inconsistent reporting of performance metrics. To address reporting heterogeneity and improve knowledge gaps, we propose the REACH checklist (Readiness and design, Execution and workflow, Access requirements, Clinical and analytical performance, and Health outcomes and economics) as a reporting framework derived directly from the gaps identified across included studies, intended to span AMR diagnostic development from proof-of-concept through clinical validation relevant to low-resource settings.