Infection and drug resistance
Economic Barriers to Antimicrobial Susceptibility Testing as a Structural Contributor to Antimicrobial Resistance in Low- and Middle-Income Countries: A Narrative Review
By Abdi YH, Bashir SG and Ali SM.
Abstract
Background
Bacterial antimicrobial resistance (AMR) was directly responsible for an estimated 1.27 million deaths in 2019, with the burden. Antimicrobial susceptibility testing (AST) is essential for guiding targeted therapy and stewardship, yet the specific economic mechanisms that prevent its scale-up in low-resource settings remain poorly understood and inadequately addressed in policy.
Methods
A narrative review was conducted following SANRA guidelines and PRISMA transparency principles. PubMed/MEDLINE, Scopus, and Google Scholar were searched (01 January 2026-30 April 2026) using Boolean combinations of terms across three domains: AST and diagnostics; economic and health-system barriers; and AMR and stewardship. Studies published 2019-2026 addressing economic barriers to AST, prescribing behaviour, resistance patterns, or financing strategies in LMICs were eligible. Evidence was synthesized thematically.