Laboratory Surveillance Systems for Antimicrobial Resistance in Low-Resource Settings: Lessons Applicable To U.S. Rural and Underserved Areas

Antimicrobial resistance (AMR) poses a critical threat to global public health, particularly in regions with limited laboratory infrastructure and surveillance capacity. While extensive research and funding have advanced AMR monitoring in high-income countries, the U.S. continues to face challenges in its rural and underserved areas, where access to healthcare and diagnostic capacity remain constrained. This study examines laboratory surveillance systems for AMR in low-resource settings worldwide and explores their potential applicability to rural and underserved U.S. contexts. A mixed-method approach was employed, combining a systematic literature review of 25 related studies from 2015-2025 with qualitative synthesis of best practices, governance models, and capacity-building strategies. Results highlight that decentralized, tiered laboratory networks, use of low-cost diagnostic tools, and community-based data integration frameworks enhance AMR surveillance effectiveness even under financial constraints. The findings underscore the importance of workforce training, public-private partnerships, and digital health innovations such as open-source data platforms to improve rural AMR surveillance in the U.S. Adapting successful low-resource strategies can strengthen national resilience, align with the CDC’s National Action Plan for Combating AMR, and promote health equity in marginalized populations. This study concludes that leveraging lessons from low-resource contexts can inform a sustainable, inclusive, and scalable AMR laboratory surveillance model tailored to the U.S. underserved healthcare system.