IntroductionTo accelerate the response to the public health threat by antimicrobial resistance (AMR), the WHO is developing a Global Research Agenda for AMR in the human health sector that aims to provide a global and transparent assessment of priority knowledge gaps related to critical bacteria—including Mycobacterium tuberculosis—and fungi that inform control and response strategies to tackle AMR by 2030. A literature scoping review represents the first phase in a stepwise process, and we hereby outline the protocol to review current knowledge gaps and research questions on AMR in the human health sector.Methods and analysisThis literature scoping review will follow the Arksey and O’Malley (2005) methodology and will include: (1) a hand search to identify relevant WHO guidelines and documents suggested by the WHO Steering Group for the AMR Global Research Agenda; (2) a grey literature search through a stakeholder mapping process and google searches of organisational websites; (3) a systematic search of relevant systematic reviews through bibliographic databases (PubMed, Embase and Web of Science); (4) screening of the reference lists of included studies. We will include relevant publications from the last 10 years (January 2012 to December 2021). Two researchers separately will review the yielded citations to determine eligibility based on predefined criteria. Relevant research questions with attributes will be extracted using a tool developed through an iterative process by the research team. Each identified research question will be classified and aggregated according to a conceptual framework (ie, ‘knowledge matrix’), composed of three themes (ie, Prevention, Diagnosis and Care & Treatment) and four cross-cutting domains (ie, Descriptive, Discovery, Development, Delivery). We will present numerical and thematic summaries of the knowledge matrix. A qualitative content analysis is out of the scope of this protocol.Ethics and disseminationThe scoping review process will only involve identification, selection and analysis of documents available for use in the public domain, and will not include any personal information on individuals, therefore ethical approval is not required. The findings will be disseminated through a peer-reviewed publication and stakeholder meetings.

BackgroundBlood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. Here, we aimed to identify barriers and enablers to BC sampling in three Southeast Asian countries.MethodsWe conducted a systematic review of studies evaluating barriers/enablers to BC sampling from 1900 to 2020 globally (PROSPERO, CRD42020206557). Using the findings of the systematic review, we developed and conducted a Theoretical Domains Framework (TDF)-based survey with a case scenario question among doctors and final-year medical students in Indonesia, Thailand and Vietnam.FindingsIn the systematic review, we identified 6,175 unique records from the databases, of which 25 met the eligibility criteria. Studies were conducted in 37 high-income countries (HICs) and 41 low- and middle-income countries (LMICs). Of 14 TDF domains, three and seven were not assessed in HICs and LMICs by the studies included in the systematic review, respectively. 1,070 medical doctors and 238 final-year medical students completed the survey. The proportion of respondents who would definitely take BC in the case scenario was 89.8% for Thai, 50.5% for Vietnamese and 31.3% for Indonesians (p<0.001). Eight TDF domains were considered key in influencing BC sampling, including ′no awareness of guideline [TDF-knowledge]′, ′low priority of BC [TDF-goals]′, ′no intention to follow guidelines [TDF-intention]′, ′level of doctors who can order or initiate an order for BC [TDF-social professional role and identity]′, ′no norms of BC sampling [TDF-social influence]′, ′perceived cost-effectiveness of BC [TDF-environmental context and resources]′, ′regulation on cost reimbursement [TDF-behavioural regulation]′ and ′consequences that discourage BC sampling [TDF-reinforcement].′ However, there was substantial heterogeneity between the countries across most domains.ConclusionsEvidence on barriers and enablers to BC sampling is limited globally. We identified individual, socio-cultural and environmental barriers/enablers to BC sampling across different countries, which represent potential targets for interventions. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.

Diabetic nephropathy, a Diabetes Mellitus’ complication, leads to chronic renal failure. Previous studies found that proximal tubule of nephron, as the initial pathogenesis of DN, precedes state of albuminuria as the current biomarker of DN. This study aimed to propose the earliest and the most accurate tubular biomarkers in predicting onset of DN and assess progression of DN. Systematic review was performed to evaluate the validity and accuracy of tubular biomarkers based on available studies in EBSCO, PubMed, and Google Scholar. Validity was measured by scoring system including studies’ methodological quality assessment based on Standards for Reporting of Diagnostic Accuracy and adjustment score to DN conventional factors. Accuracy evaluation was reviewed based on accuracy value provided. From the total of 560 studies, 10 included studies were assessed and 5 biomarkers were compared. All studies were considered valid, except one study on NGAL marker. Based on their likelihood ratios for clinical application, N-acetyl-β-D-glucosaminidase (NAG) has the best accuracy in predicting onset of DN and Cystatin C in assessing progression of DN. Detection of these biomarkers could be applied clinically through quantitative and semi-quantitative method for potential use in all healthcare levels and locations. This review proposed the usage of NAG and Cystatin C as early and accurate diabetic nephropathy tubular biomarkers in all healthcare level.