Risk factors for nontuberculous mycobacterial isolation in patients with cystic fibrosis: A meta-analysis

摘要

Background To better understand the mechanisms of infection with nontuberculous mycobacteria (NTM) in patients with cystic fibrosis (CF), we explore different risk factors associated with NTM positivity in a meta-analysis. Methods Studies published before 31 July 2019 were selected from MEDLINE. Combined odds ratios (ORs) were calculated by pooling the ORs of each study. The weighted mean difference (WMD) was used for continuous numerical measurements. Summary data were pooled using fixed- or random-effects models according to the presence of heterogeneity (P 50). Results Nineteen studies with a total of 23 418 patients, of whom 1421 (6) were diagnosed as NTM positive, were included. Older age was significantly associated with NTM positivity (WMD = 2.12, 95 confidence interval CI: 1.11-3.13;P < .01, fixed-effects model). The OR forStaphylococcus aureuscolonization was 1.66 (95 CI: 1.21-2.26;P = .001) in 11 studies (8091 patients), the OR forAspergillus fumigatuscolonization was 3.59 (95 CI: 3.05-4.23;P < .001) in 11 studies (20 480 patients), and the OR forStenotrophomonas maltophiliacolonization was 3.41 (95 CI: 2.66-4.39;P < .01) in seven studies (14 935 patients). Oral corticosteroids were significantly associated with NTM positivity (OR = 1.98, 95 CI: 1.24-3.16;P < .01, 6 studies, 1936 patients). No other factor showed a significant association. Conclusion Older age,S.aureus,S.maltophilia, andA.fumigatuschronic colonization, and oral corticosteroids were significantly associated with an increased risk of NTM positivity. CF patients with more severe conditions should be closely monitored for NTM.