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 were included in this
review. All 95 studies reported on NTM infection, and 14 of these also
reported on NTM-PD. The pooled estimate for the point prevalence of NTM
infection was 7.9% (CI 95%, 5.1–12.0%). In meta-regression, sample size
and geographical location of the study modified the estimate. Longitudinal
analysis of registry reports showed an increasing trend in NTM infection
prevalence between 2010 and 2019.  Conclusions: The
overall prevalence of NTM infection in CF is 7.9% and is increasing over
time based on international registry reports. Future studies should report
screening frequency, microbial identification methods, and incidence rates
of progression from NTM infection to pulmonary disease.