Penicillin allergy de-labelling implementation intervention in a UK hospital: a process evaluation, the patient experience.

Background: Penicillin allergy (penA) records are common, but true penA is rare. PenA records are associated with broad spectrum antibiotic prescribing and negative patient outcomes. We developed a behavioural intervention package to support inpatient penicillin allergy de-labelling (PADL) delivered by a multi-profession non-allergist workforce to remove incorrect penA records from medical and surgical adult inpatients in a UK hospital.

Procalcitonin to guide antibiotic use during the first wave of COVID-19 in English and Welsh hospitals: integration and triangulation of findings from quantitative and qualitative sources.

Aim: To integrate the quantitative and qualitative data collected as part of the PEACH (Procalcitonin: Evaluation of Antibiotic use in COVID-19 Hospitalised patients) study, which evaluated whether procalcitonin (PCT) testing should be used to guide antibiotic prescribing and safely reduce antibiotic use among patients admitted to acute UK National Health Service (NHS) hospitals.

Design: Triangulation to integrate quantitative and qualitative data.

Setting And Participants: Four data sources in 148 NHS hospitals in England and Wales including data from 6089 patients.

Description of the combined evidence-based, theory-based and person-based approaches used to develop a behavioural intervention package to support non-allergist healthcare workers to remove incorrect penicillin allergy records from medical and surgical adult inpatients in a UK hospital.

Objectives: To develop a behavioural intervention package to support non-allergist healthcare workers (HCWs) to remove incorrect penA records from medical and surgical adult inpatients. This paper describes the development of the penicillin allergy de-labelling (PADL) intervention and the implementation intervention that will support non-allergist-delivered PADL.

Design: We combined evidence-based, theory-based and person-based approaches.

Direct oral penicillin challenge in secondary care with low-risk patients: the SPACE mixed-methods study with cost-effectiveness analysis.

Background: One in five inpatients carries a penicillin allergy label. However, 90-95% of labels are incorrect. Penicillin allergy labels lead to increased risk for serious hospital infections and longer hospital stay and are associated with higher estimated healthcare costs.

Hospital Clinicians' Knowledge of and Opportunity and Motivation for Prescribing Short Antibiotic Courses for Common Infections.

Short-course antibiotic therapies for common infections treated in hospital are supported by national guidelines. Hospital clinicians' knowledge of the course length recommendations for the management of common infections has not been fully explored. This study aims to assess doctors' knowledge of and explores their opportunity and motivation for prescribing short-course therapy.

Penicillin Allergy Management in India and Sri Lanka: Current Challenges.

Data regarding Penicillin allergy labels (PALs) from India and Sri Lanka are sparse. Emerging data suggests that the proportion of patients declaring an unverified PAL in secondary care in India and Sri Lanka (1%-4%) is lesser than that reported in High Income Countries (15%-20%). However, even this relatively small percentage translates into a large absolute number, as this part of the world accounts for approximately 25% of the global population.

Narrative review of recent developments and the future of penicillin allergy de-labelling by non-allergists.

This article outlines recent developments in non-allergist delivered penicillin allergy de-labelling (PADL), discusses remaining controversies and uncertainties and explores the future for non-allergist delivered PADL. Recent developments include national guidelines for non-allergist delivered PADL and validation of penicillin allergy risk assessment tools. Controversies remain on which penicillin allergy features are low risk of genuine allergy.

Characteristics, risk factors and clinical impact of penicillin and other antibiotic allergies in adults in the UK General Practice: A population-based cohort study.

Objective: To assess the characteristics, risk factors and clinical impact of penicillin and other antibiotic allergy labels in general practice in the UK.

Design: Population-based cohort study.

Setting: Primary care in the UK, 2000-2018.

A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19.

Background: Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK.

Objectives: Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic.

Factors influencing implementation and adoption of direct oral penicillin challenge for allergy delabelling: a qualitative evaluation.

Background: Over 95% of penicillin allergy labels are inaccurate and may be addressed in low-risk patients using direct oral penicillin challenge (DPC). This study explored the behaviour, attitudes and acceptability of patients, healthcare professionals (HCPs) and managers of using DPC in low-risk patients.

Methods: Mixed-method, investigation involving patient interviews and staff focus groups at three NHS acute hospitals.

The appropriateness of penicillin allergy de-labelling by non-allergist clinical ward teams.

Objectives: We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin.

Methods: Opportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history.

Eliciting the barriers and enablers towards anaesthetists giving penicillin-based antibiotic prophylaxis to low-risk patients who have had their penicillin allergy label removed as part of a preoperative delabelling process.

Background: Some penicillin allergy labels can be removed by non-allergy specialists by direct oral challenge, but there is reluctance amongst anaesthetists to give penicillin to these patients. We aimed to assess anaesthetist beliefs about giving penicillin to patients delabelled by direct oral challenge.

Methods: A survey, developed using the Theoretical Domains Framework, was circulated to anaesthetists within a regional research network in England.

Experiences of an inpatient penicillin allergy de-labelling pathway: capturing the patient voice.

Background: Non-allergist-delivered penicillin allergy de-labelling (PADL) is supported by UK and other national guidelines but is not yet routine practice in UK hospitals. Those who have undergone PADL report high rates of acceptance, but it is unknown why some continue to avoid penicillin, and why some decline testing.

Objectives: To explore the experiences of patients recently approached for penicillin allergy (penA) assessment and de-label by non-allergists in a UK hospital to determine the barriers and enablers to patient acceptance of PADL.

Non-allergist healthcare workers views on delivering a penicillin allergy de-labelling inpatient pathway: identifying the barriers and enablers.

Background: Non-allergist delivered PADL is supported by UK and World Health Organization guidelines but is not yet routine in UK hospitals. Understanding the views of healthcare workers (HCWs) on managing patients with penA records and exploring perspectives on delivering a PADL inpatient pathway are required to inform the development of non-allergist delivered PADL pathways.

Objective: To explore the perspectives of non-allergist HCWs working in medical specialties on managing patients with penA records, and to explore the enablers and barriers to embedding PADL as a standard of care for inpatients.

Penicillin allergy de-labelling by non-allergists: a comparison of testing protocols.

Optimizing penicillin allergy de-labelling (PADL) to ensure patients with an incorrect penicillin allergy record are de-labelled with minimal patient harm is important for antibiotic stewardship. The heterogeneity of inclusion and exclusion criteria in the published penicillin allergy testing protocols risks suboptimal delivery of PADL. We compared the similarities and the differences between non-allergist-delivered PADL testing protocols and make suggestions for harmonization.

Removal of incorrect penicillin allergy labels in a UK hospital.

Objectives: Penicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital.

Methods: A daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use.

Geoforensic search to crime scene: Remote sensing, geophysics, and dogs.

In the absence of surface indications of burial sites, law enforcement or humanitarian organizations are faced with the difficult task of focusing large-scale ground searches to a manageable excavation area. A geoforensic-based survey may exclude parts of the landscape for reasons such as diggability or viewshed analysis but leave areas still too large for invasive exploration. This work examines how drone-based remote sensing, geophysics, and search dogs may be combined to narrow such searches.

Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey.

Introduction: Antibiotic use drives antibiotic resistance. The UK antimicrobial resistance (AMR) strategy aims to reduce antibiotic use. We aimed to quantify excess antibiotic use in a district general hospital in south-west England.

Procalcitonin Evaluation of Antibiotic Use in COVID-19 Hospitalised Patients (PEACH): Protocol for a Retrospective Observational Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a viral illness, many patients admitted to hospital are prescribed antibiotics, based on concerns that COVID-19 patients may experience secondary bacterial infections, and the assumption that they may respond well to antibiotic therapy. This has led to an increase in antibiotic use for some hospitalised patients at a time when accumulating antibiotic resistance is a major global threat to health.