Extended‐spectrum beta‐lactamase (ESBL)‐producing Enterobacteriaceae and urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

Probably not a substantial claim: may not pass S3 (load-bearing).

The remaining studies reported a total of 1448 Enterobacteriaceae strains cultured and identified as ESBL producers.

“The remaining studies reported a total of 1448 Enterobacteriaceae strains cultured and identified as ESBL producers.”

May combine two claims.

Among the remaining studies reporting specific ESBL-P organisms, E coli was the most commonly reported organism, with a pooled prevalence of 61% (95% CI 47-74).

“The most commonly reported organisms were E coli with a pooled prevalence of 61% (47, 74%)”

May combine two claims.

Although the point prevalence of ESBL-P Enterobacteriaceae was higher in Africa than in India, the 95% CIs overlap, showing no significant difference between these two regions.

“Although the point prevalence of ESBL-P Enterobacteriaceae was higher in Africa than in India, there was considerable overlap between 95% CIs of these two regions showing no significant difference.”

• AssumptionRests on an assumption: Asymptomatic bacteriuria is clinically significant and requires antibiotic treatment during pregnancy.

May combine two claims.

The global pooled prevalence of ESBL-producing Enterobacteriaceae among pregnant/postpartum women with UTI or asymptomatic bacteriuria is 25% (95% CI 18-32), with high heterogeneity (I2 = 98.8%).

“The pooled prevalence of ESBL-P Enterobacteriaceae was 25% (95% CI 18, 32%); I 2 = 98.8%.”

• Also stated in: § Abstract · plain

  “The global prevalence of ESBL(extended-spectrum beta-lactamase)-producing Enterobacteriaceae among pregnant women diagnosed with urinary tract infections (UTIs) is 25% with the highest rates in Africa (45%) and India (33%) and the lowest one in North America (3%).”

• AssumptionRests on an assumption: Asymptomatic bacteriuria is clinically significant and requires antibiotic treatment during pregnancy.

Probably not a substantial claim: may not pass S3 (load-bearing).

Four included studies did not report the frequency of specific ESBL-P organisms.

“Four studies did not report the frequency of specific ESBL-P organisms.24,29,41,45”

May combine two claims.

The pooled prevalence of ESBL-P E coli isolates was 17% (95% CI 9, 24%), with I2 = 88.27%.

“The pooled prevalence of ESBL-P E coli isolates was 17% (95% CI 9, 24%), I 2 = 88.27%; Figure 5.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Determining potential risk factors of ESBL acquisition such as socioeconomic status, recent antibiotic use and hospitalisation was not amenable.

“Determining the potential risk factors of ESBL acquisition such as socioeconomic status, recent antibiotic use and hospitalisation was not amenable.”

May combine two claims.

Subgroup analyses gave prevalence figures of 21% in symptomatic UTI patients and 28% in those with AB.

“By analysing the subgroups, these figures were 21% in symptomatic UTI patients and 28% in those with AB.”

May combine two claims.

A restricted number of studies was found in North America (two studies) and South America (only one study).

“Also, restricted number of studies was found in North America (two studies) and South America (only one study).”

May combine two claims.

There was high variability in ESBL-P Enterobacteriaceae prevalence by geographic region, with the highest rates in Africa (45%) and India (33%) and the lowest in North America (3%) and Europe (5%).

“There was high variability regarding the prevalence of ESBL-P Enterobacteriaceae in different geographic regions as the highest rates were seen in Africa (point prevalence of 45%) and India (point prevalence of 33%) and the lowest ones belonged to North America (3%, although only two studies were found from this area) and Europe (5%).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most studies included in the review had been performed in India.

“Likewise, in India where most studies included in the presented study had been performed”

May combine two claims.

The evidence highlights challenges regarding AB and the benefit-to-harm balance of its antibiotic treatment during pregnancy.

“This evidence highlights the challenges regarding AB and benefit to harm balance of its antibiotic treatment during pregnancy.”

• AssumptionRests on an assumption: It is established practice to treat asymptomatic bacteriuria during pregnancy with antibiotics.

Probably not a substantial claim: may not pass S3 (load-bearing).

These pathogens have been implicated in the WHO global priority list of antibiotic-resistant bacteria.

“These pathogens have been implicated in the recent priority list of antibiotic resistance bacteria globally (global PPL) developed by the WHO to emphasise the development of new antibiotics.66”

• cites [66]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two authors independently screened titles and abstracts, and discordance was resolved by discussion, full-text review, and if required a third author.

“Two authors independently screened the titles and abstracts of the search results to identify relevant studies.Then, the number of retained articles were compared and any discordance was solved by discussion, reviewing the full text of the article, and if required comments of a third author.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Reporting bias was assessed using Begg's nonparametric test and Egger's parametric test, with significance level 0.05.

“the nonparametric Begg's test and parametric Egger's test 23 were used to assess the reporting bias.The significance level was considered as 0.05.”

• cites [23]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Sensitivity analysis did not show any individual study to have a great effect on the overall estimate; all point estimates were within the overall confidence interval.

“Sensitivity analysis did not show any individual study to have great effect on the overall estimate (all point estimates are within the overall confidence interval)”

May combine two claims.

A systematic review of 14 interventional studies reported a 75% reduction in pyelonephritis incidence following treatment of AB in pregnancy, although the evidence was uncertain mainly due to high risk of bias.

“In a systematic review of 14 interventional studies, 75% reduction in pyelonephritis incidence was reported following the treatment of AB in pregnancy, although the evidence for the estimate of effectiveness of this practice was defined as uncertain mainly owing to high risk of bias in the included studies.67”

• cites [67]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

A previous systematic review of African studies reported a pooled prevalence of infection/colonisation by ESBL pathogens in pregnancy/postpartum as 17%.

“In a previous systematic review performed on studies from African countries, 13 the authors reported a pooled prevalence of infection/ colonisation by ESBL pathogens in pregnancy/postpartum period as 17%.”

• cites [13]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

A recent systematic review reported that 8% of pregnant/postpartum women were colonised with ESBL-P Enterobacteriaceae globally.

“A recent systematic review reported that 8% of pregnant/postpartum women were colonised with ESBL-P Enterobacteriaceae globally.14”

• cites [14]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The observed geographic variations could be justified by many factors beyond the scope of the analysis.

“The observed variations in different geographic areas could be justified by many factors that were beyond the scope of this analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A 2016 study in India reported ESBL-P Enterobacteriaceae prevalence of 57.1%.

“In a recent study carried out in 2016 in India, this prevalence rose to 57.1%.34”

• cites [34]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The review complies with the PRISMA 2009 recommendations.

“The review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009.15”

• cites [15]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Several authors were contacted to extract required data because pregnant women often comprised a subset of the study population and required statistics were often not reported.

“We tried to contact several authors to extract the required data as in many studies, pregnant women comprised a subset of the study population and it was not uncommon not to find required statistics in this group of patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A comprehensive search without any language restriction was performed.

“We tried to perform a comprehensive search without any language restriction.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A random effects model was used to have a more conservative estimate.

“The reporting bias was ignorable and a random effects model was used to have a more conservative estimate.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A 2004 study in India reported ESBL-P Enterobacteriaceae prevalence of 35.9%.

“Likewise, in India where most studies included in the presented study had been performed, prevalence of ESBL-P Enterobacteriaceae in a study performed in 2004 was 35.9%.38”

• cites [38]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Risk of bias in each included study was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies.

“In order to determine the risk of bias in each study separately, the Joanna Briggs Institute (JBI) Checklist for Prevalence Studies was used.20”

• cites [20]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Of the 23 included studies, 17 were high quality and 6 were low quality according to the JBI checklist.

“Of 23 included studies, 17 studies [24][25][26][29][30][31][32][33][34][37][38][39][40][41][42]44,46 had high quality and 6 studies had low quality. 27,28,35,36,43,45”

Probably not a substantial claim: may not pass S3 (load-bearing).

Another previous systematic review determined maternal colonisation with ESBL-P Enterobacteriaceae as 8% (95% CI 5-10).

“The other systematic review determined maternal colonisation with these organisms as 8% (95% CI, 5%-10%).14”

• cites [14]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

Access to healthcare services, finite healthcare resources in developing countries, self-administered antibiotic use, empiric antibiotic administration and similar factors could all play a role in the geographic variations.

“Access to healthcare services, finite healthcare resources in developing countries, self-administered antibiotic use, empiric antibiotic administration and similar factors all could play role in the variations.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A data gathering checklist was developed, full-text articles were reviewed by two authors separately, and disagreements or unclear data were resolved by discussion or by contacting authors.

“A data gathering checklist was developed considering the required variables.The included full-text articles were reviewed by two authors separately.Then, through discussion, if required, the required data were finalised.Any disagreement or unclear data were resolved by trying to contact the authors of the report.”