Global burden of non-tuberculous mycobacteria in the cystic fibrosis population: A systematic review and meta-analysis

Background: People living with cystic fibrosis have an increased risk of lung infection with non-tuberculous mycobacteria (NTM), which is reportedly increasing. We conducted a systematic review of the literature to estimate the burden (prevalence and incidence) of non-tuberculous mycobacteria in the cystic fibrosis population. 
Methods: Electronic databases, registries, and grey literature sources were searched for cohort and cross-sectional studies reporting epidemiological measures (incidence and prevalence) of NTM infection or NTM pulmonary disease (NTM-PD) in cystic fibrosis. The last search was conducted in September 2021; we included reports since database creation and registry reports published since 2010. The methodological quality of studies was appraised with the Joanna Briggs Institute tool. A random-effects meta-analysis was conducted to summarize the prevalence of NTM infection, and the remaining results are presented in a narrative synthesis. 
Results: Ninety-five studies ..., Review question
We designed our review question based on population, condition, outcome (epidemiological measure) and study design, as recommended by current guidelines. Briefly, we screened for cross-sectional or cohort studies reported in English including people with CF (population) and evaluating NTM infection or NTM-PD (condition). NTM infection was defined as isolation of any NTM on at least one occasion per patient; the criteria for NTM-PD were specified in each study. Reporting of at least one epidemiologic measure among incidence rate, incidence proportion, point prevalence, or period prevalence was required for inclusion. The full criteria are described in Supplementary Table 1. The review protocol was registered to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42020200418) in July 2020. In October 2020, before the abstract screening, we updated the grey literature sources and screening procedures.
Literature search
EMBASE and MEDLINE were searched..., Requires R version 4.1 or higher and a spreadsheet program (MS Excel) to explore the collected datasets. The R studio IDE was used to conduct R analyses and document procedures. The list of packages (with versions) necessary to reproduce the results is specified inside the scripts.Â