Antimicrobial Resistance in Refugee Camps and Prisons: A Global Scoping Review of Primary Studies on Burden, Risk Factors, Surveillance, and Mitigation Strategies.

Background: AMR is a global health threat, and prisons and refugee camps are high-risk environments for the acquisition and spread of multidrug-resistant organisms (MDROs). This scoping review aims to map the existing evidence on antimicrobial resistance (AMR) in prisons and refugee camps, focusing on burden, risk factors, surveillance, resistance patterns, and mitigation strategies. Methods: The scoping review followed the Arksey and O'Malley methodology and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) checklist. Using predefined search terms related to AMR, literature was identified through searches of SCOPUS, PubMed/MEDLINE, Google Scholar, the Directory of Open Access Journals (DOAJ), and grey literature sources, including reports from the World Health Organization (WHO) and the United Nations High Commissioner for Refugees (UNHCR). The literature was screened based on inclusion and exclusion criteria to select relevant studies. Studies were screened based on predefined inclusion and exclusion criteria, and data were extracted into Microsoft Excel for descriptive and thematic analysis. Results: From 3659 records identified at the initial search, 26 primary studies from 18 countries met the inclusion criteria. Most studies addressed AMR burden (65.4%), followed by risk factors (26.9%), while surveillance and mitigation strategies were each addressed in 3.8% of studies. Key themes were categorized as primary focus, while additional themes were recorded as secondary focus areas. Overall, the studies reported a high prevalence of multidrug-resistant organisms. MRSA colonization reached 15.7% in Swiss refugee canters and 21.3% in Finnish cohorts, while ESBL carriage was as high as 32.9%. Additionally, multidrug-resistant tuberculosis (MDR-TB) prevalence reached 9.5% in Ethiopian prisons. Risk factors included prior hospitalization, self-medication, prolonged antibiotic exposure, treatment interruptions, overcrowding, and poor hygiene Surveillance efforts were limited, and evidence on mitigation strategies was scarce, with only two studies describing antimicrobial stewardship program (ASP) implementation in prison settings in Italy and the United States. Conclusion: The review shows that overcrowding, inadequate sanitation, interrupted healthcare, and poor stewardship are the main causes of the high incidence of AMR in prison and refugee camps. To protect these susceptible groups and stop the spread of AMR worldwide, it is critically necessary to improve surveillance, infection control, and context-specific mitigation techniques.