BackgroundPatients are commonly reported as being allergic to beta-lactam (BL) antibiotics. However, many patients with this reported allergy are able to receive BL treatments because they do not have true allergies. In many cases these are simply intolerances due to side effects reported as an allergy. Delabelling these patients leads to better clinical outcomes, optimal antibiotic usage, decreased bacterial resistance and reduced healthcare costs. Therefore, the aims of this study were to identify incorrectly labelled BL allergies in hospitalised patients and to assess antibiotic use in delabelled patients in order to establish a quality indicator to optimise antimicrobial treatments.MethodsA prospective study was conducted in which hospitalised patients treated with antimicrobial drugs and labelled as ‘BL-allergic’ were identified by clinical pharmacists. An allergist assessed whether patients were suitable candidates for a skin test or oral challenge. The Allergy Service removed ‘BL-allergic’ labels if negative results were obtained. Delabelled patients were followed up by clinical pharmacists to study the use of BL antibiotics as a result of the delabelling programme.ResultsA total of 176 suspected allergic patients were identified and 91 (51.7%) were tested either by a skin test or oral challenge based on the patient indicators. Seven (16.4%) patients tested were allergic to BL antibiotics, 76 (83.5%) were totally delabelled and eight (0.1%) were partially delabelled. Thirty-two (38.1%) delabelled patients required antibiotic treatment in another inpatient or outpatient setting, of whom 27 (84.3%) patients with a new infectious episode received BL treatments while five (15.7%) continued to receive antimicrobial treatments without BL.ConclusionAfter the implementation of a protocol to detect incorrect BL allergy labels, 83.5% of the patients in this cohort were completely delabelled. This shows that there is a clear opportunity to optimise the use of antibiotics by delabelling ‘BL-allergic’ patients.

questionnaire before and after the information sessions. The score of their satisfaction with the information received before and after the sessions was also collected.Fifteen days after discharge, the patients were telephoned and a further survey was carried out.The reasons for unscheduled readmissions in the period were mainly worsening of the respiratory function test and fever. Results Of the 129 lung transplanted patients in the period studied, 114 completed both questionnaires. 70 were men and the average age was 55 years. The causes of transplantation were: diffuse interstitial pulmonary disease: 58, chronic obstructive pulmonary disease: 29; bronchiectasis/ cystic fibrosis: 17; other causes: 7; pulmonary hypertension: 3.99 transplants were double-lung, 20 left single-lung and 10 right single-lung.The percentage of correct answers varied from 70% in the pre-questionnaire to 85% in the post-questionnaire (p=0.000).The score of the patients' satisfaction with the information received was 6.6 points in the pre-questionnaire and 9.3 in the post-questionnaire (p=0.000).114 telephone calls were made to patients' homes in order to complete the post-questionnaire.In the first 90 days after transplantation, 27% of the transplanted patients were readmitted unscheduled in 2020 compared with 38.2% in 2016 (control group) (p=0.225). Conclusion and relevancePharmaceutical care for lung transplant patients statistically significantly improved their knowledge about medicines and healthy lifestyles as well as their degree of satisfaction with the information received, and statistically significantly improved the unscheduled readmissions in the first 90 days after transplantation.

Background: We investigated physical and chemical stability of daptomycin and vancomycin in heparin or sodium citrate lock solutions. The aim of this study was to find the optimal combination of antimicrobials and additives for lock solutions, which maximized patient safety. Methods: Vancomycin and daptomycin were diluted with heparin or sodium citrate to achieve final concentrations of vancomycin-heparin 2.5 mg/mL–833.33 U/mL, vancomycin-citrate 2.5–33.3 mg/mL, daptomycin-heparin 5 mg/mL–800 U/mL, and daptomycin-citrate 5–32 mg/mL and they were stored at room temperature (+25°C), 4°C, −20°C, and 37°C. Physical and chemical stability were analyzed for each antibiotic-anticoagulant combination in all conditions immediately after preparation, at 24, 48, 72 h and at different time points until unstable concentrations were obtained. Daptomycin-sodium citrate microbiological activity was also studied by evaluating two Staphylococcus aureus cultures in a calcium enriched medium with a daptomycin E test, with and without sodium citrate. Results: After incubation at 37°C vancomycin and daptomycin combined with heparin retained at least 90% of the initial concentration over 48 h. Vancomycin-sodium citrate solution stored at 37°C reduced more than 10% of the initial concentration at 24 h. On the other hand, daptomycin-sodium citrate preparation was stable at 37°C for 72 h but the microbiological activity of daptomycin was lower in the presence of sodium citrate. Conclusions: The purpose is to prepare vancomycin and daptomycin lock solutions combined with heparin. They should be changed at 48 h and its stability is over 3 days at 25°C and 7 days at 4°C, which allow Hospital Pharmacy Services to manage their stocks. Daptomycin-sodium citrate combination is more stable for extended periods but its bioactivity has not been demonstrated.