{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:17:54Z","timestamp":1788513474602,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research University College London Hospitals Biomedical Research"},{"name":"Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Unconfirmed penicillin allergy labels restrict antibiotic options and drive deviation from antimicrobial guidelines. To address this, we established an infection-embedded penicillin allergy de-labelling (PADL) service embedded within existing infection-liaison touchpoints (microbiology meetings, advice calls and infection reviews) to target patients with active infection needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of all 189 referrals to our PADL service (March 2022 to December 2025), nested within a baseline prevalence review of 218\u200a375 admissions. Furthermore, to quantify the clinical cost of allergy labels, we surveyed infection experts, using 20 clinical vignettes, to determine prescribing variance had de-labelling not occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of patients, 82.5% (156\/189) were classified as having acute, complex or recurrent infection; 45% (85\/189) were directly de-labelled, while 41.8% (79\/189) were excluded by low-risk criteria prompting specialist referral for full penicillin allergy testing. Critically, for patients on active therapy, de-labelling triggered an immediate regimen change in 84.1%, driving a 43% intravenous-to-oral switch rate, a mean reduction of 0.7 antibiotics per patient and significantly reducing antibiotic spectrum coverage (P\u200a=\u200a0.0004). Expert review of vignettes revealed only minimal concordance on alternative regimens (Fleiss\u2019 kappa 0.28) had we not de-labelled, implying that persistent labels lead to non-standardized prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Infection-embedded de-labelling is a high-yield intervention that can deliver immediate stewardship returns in patients with active infection needs. A caveat is that a significant proportion of excluded patients require specialist allergy referral, carrying resource implications and underscoring the need for careful planning with local allergy services at inception of \u2018low-risk\u2019 pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag189","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:50:04Z","timestamp":1786798204000},"source":"Crossref","is-referenced-by-count":0,"title":["Infection-embedded penicillin allergy de-labelling delivers immediate antimicrobial stewardship gains in patients with active infection"],"prefix":"10.1093","volume":"8","author":[{"given":"Stephanie","family":"Harris","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology, University College London Hospitals , London 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,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Kew","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Royal Free London NHS Foundation Trust , London ,","place":["UK"]},{"name":"Hospital for Tropical Diseases, University College London Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6329-8199","authenticated-orcid":false,"given":"Cassandra","family":"Watson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, London North-West University Healthcare NHS Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"McGregor","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, London North-West University Healthcare NHS Trust , London 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