June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
The Effect of ESwabs on Laboratory Test Utilization and Positivity Rates in Microbial Keratitis Patients
Author Affiliations & Notes
  • Keith D Miller
    Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Avi Toiv
    Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Callie Deng
    Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Ming-Chen Lu
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Leslie M. Niziol
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Jenna N. Hart
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Eric Sherman
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Shahzad Mian
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Paul R Lephart
    Pathology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Alan Sugar
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Linda Kang
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Maria A. Woodward
    Ophthalmology and Visual Sciences, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Keith Miller None; Avi Toiv None; Callie Deng None; Ming-Chen Lu None; Leslie Niziol None; Jenna Hart None; Eric Sherman None; Shahzad Mian None; Paul Lephart None; Alan Sugar None; Linda Kang None; Maria Woodward None
  • Footnotes
    Support  NEI R01 EY031033, Susan Lund Ophthalmology Fund, Research to Prevent Blindness Career Advancement Award
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5162. doi:
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    • Get Citation

      Keith D Miller, Avi Toiv, Callie Deng, Ming-Chen Lu, Leslie M. Niziol, Jenna N. Hart, Eric Sherman, Shahzad Mian, Paul R Lephart, Alan Sugar, Linda Kang, Maria A. Woodward; The Effect of ESwabs on Laboratory Test Utilization and Positivity Rates in Microbial Keratitis Patients. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5162.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Positive lab results are critical in providing targeted treatment for microbial keratitis (MK). We performed a retrospective, observational clinical study to investigate the utilization and positivity rates of lab tests associated with MK over time and during a 2018 departmental switch to Copan Diagnostic's ESwab specimen collection.

Methods : MK patients with associated lab tests were identified in the University of Michigan electronic health record from August 2012 to April 2022. Lab results were classified as lab-positive or lab-negative and trends over time were assessed using linear regression. We randomly sampled 53% of patients who had labs, stratified by diagnosis year, for chart review of ocular history and pretreatment. Multivariable logistic regression was used to assess the association of ESwab, age, and ocular characteristics with the probability of positive lab results. An interaction between the clinic setting (Cornea Clinic vs other clinics) and ESwab use was also investigated.

Results : Of 3395 MK patients identified, 31% (n=1065) had labs performed. Specimens were collected with ESwab in 48% of cases (0% in 2012-2017, 53% in 2018, 100% in 2019-2022). The rate of lab testing significantly increased over time (slope estimate=2.5% per year, p<0.001; 20.1% in 2013 to 42.4% in 2021) and was higher after ESwab implementation (26.7% before vs. 38.6% after, p<0.001). The lab positivity rate decreased after ESwab use (54.8% before vs. 43.4% after, p<0.001). Labs had lower odds of being positive if specimens were collected using ESwabs (odds ratio [OR]=0.60, 95% CI=0.42-0.86, p=0.006), patients had no steroid pretreatment (OR=0.49, 95% CI=0.33-0.74, p=0.001), and there was an increase in the number of antibiotics prescribed prior to presentation (OR=0.75, 95% CI=0.62-0.91, p=0.003). Specimens obtained using ESwabs were associated with lower odds of positive lab results at the Cornea Clinic (OR=0.56, 95% CI=0.32-0.99, p=0.04), but not significantly lower at other clinics (OR=0.71, 95% CI=0.30-1.71, p=0.75).

Conclusions : Before ESwab implementation, fewer MK patients were tested using ESwabs. It is possible that the convenience and ease of use of the ESwab led to increased test utilization, contributing to a lower positivity rate.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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