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Sensitivity analyses were conducted to see the effect of removing studies reporting 0% clustering, with only extrapulmonary TB cases, only Mycobacterium bovis cases, studies using the ��old 12�� MIRU loci as part of their 15 loci, and studies assessed as having a high likelihood of bias (STROME-ID score less than 20). Results The search identified 7274 references resulting in 27 studies (25 journal articles and 2 conference abstracts) included after deduplication and title/abstract/full text screening (figure 1). The main characteristics of the included studies are shown in table 1. Studies were published between 2007 and 2014 and the clustering reported varied from 0%37 to 62.8%.38 In all studies, clustered isolates were defined as having identical strain types based on the MIRU-VNTR loci typed, with or without Spoligotyping. Seventeen Ritipenem studies included isolates from newly diagnosed TB cases, three studies reported including isolates from new and chronic cases of TB, and seven did not report this information. In addition, 10 studies did not include repeat isolates from the same patient, one study included a repeat isolate from one patient SN-38 in vitro and the remaining 17 did not report whether repeat isolates were included or not. Furthermore, four studies included isolates with missing loci in the cluster analysis, whereas four excluded isolates with missing loci and the remaining 20 did not report how they dealt with missing loci. The number of studies reporting each variable of interest is shown in table 2. STROME-ID scores can be found in online supplementary appendix 2. Table?1 The study setting and design characteristics of the included articles Table?2 The number of studies that reported the variables of interest Figure?1 Results of systematic search, screening and data extraction. A forest plot shows the spread of clustering reported by number of loci and additional typing method (figure 2). Significant heterogeneity was identified between the studies (pselleck chemicals llc showing the proportion of clustering reported in each study by the number of MIRU-VNTR loci typed. The number of loci typed is categorised into 15 loci (m15), 15 loci with Spoligotyping (m15?s), 24 loci (m24) and 24 loci with Spoligotyping ... The univariable metaregression shows evidence for the proportion of clustering to decrease as the number of MIRU-VNTR loci typed increased from 15 to 24 (p=0.04; table 3), accounting for 14% of the between study variation, and to increase when the study participants consented to being included in the study (p=0.03), accounting for 14% of the between study variation. The proportion of clustering increased as the TB incidence in the population increased (p=0.007, adjusted R2=26.7). There was also evidence for the proportion of clustering to increase as the maximum cluster size increased (p=0.
