Determinants of inequalities in antimicrobial-resistant bloodstream infections among socioeconomically disadvantaged populations in high-income countries: a systematic review protocol

<ns5:p> 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 systematic review is to ascertain the drivers and risk factors contributing to inequality in the incidence and burden of AMR BSI 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. Thirteen reviewers will complete screening of allocated abstracts and titles for eligibility and a large language model will conduct a secondary screening. A single reviewer will complete full text screening and two independent reviewers will complete data extraction from eligible papers and conduct risk of bias assessments. A narrative synthesis will summarise findings, with meta-analysis conducted where feasible. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; <ns5:ext-link xmlns:ns6="http://www.w3.org/1999/xlink" ext-link-type="uri" ns6:href="https://www.crd.york.ac.uk/PROSPERO/view/CRD42024601049">CRD42024601049</ns5:ext-link> ). Ethics and dissemination We will identify risk 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. </ns5:p>