Closing the Diagnostic Equity Gap in Antimicrobial-Resistant Healthcare-Acquired Infections: A Narrative Review and Call to Action

Purpose of Review Antimicrobial-resistant (AMR) infections pose a global public health threat, and healthcare-acquired infections (HAIs) are a major driver. Bloodstream infections (BSIs) account for a large share of AMR HAIs and contribute to high mortality and morbidity. Low- and middle-income countries (LMICs) and highly vulnerable populations in high-income countries (HICs) are disproportionately represented among those diagnosed with AMR BSIs. Diagnostics are central to managing AMR BSIs, yet equitable access to these tools remains underdiscussed. This review characterizes the diagnostic landscape for AMR BSIs, describes inequities in access and use, and outlines strategies to close these gaps. Recent Findings While conventional blood culture remains the gold standard for BSI diagnosis, rapid molecular, phenotypic, and culture-independent diagnostic platforms substantially shorten time to pathogen identification and susceptibility results. However, the clinical benefit of rapid blood culture diagnostics depends heavily on antimicrobial stewardship and access to novel and first-line therapies. Despite these advances, many facilities within LMICs lack access to even the simplest diagnostic tests. In HICs, adoption is concentrated in large academic hospital systems, and recent research has shown that test ordering may vary with patients’ social vulnerability. Randomized clinical trials establishing the value of rapid diagnostics are conducted almost entirely in HICs and among adult, non-immunocompromised populations, leaving gaps in LMIC settings and among immunocompromised or pediatric patients. Diagnostic platforms validated on narrow populations may underperform in underrepresented groups, thereby perpetuating diagnostic bias. Summary Diagnostic equity is an underutilized concept for addressing AMR BSIs. Closing this gap requires positioning diagnostics as a global necessity and placing equity at the forefront of their deployment.