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P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1, 2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined. We report on AALs and their impact on a cohort of Australian LTRs.A retrospective matched-cohort study was conducted over a 5-year period (2010 to 2015) at an Australian liver transplant center (Austin Health). Using a departmental liver transplant database, LTRs with an AAL (AAL group) were identified. The same number of matched controls (LTRs without an antibiotic allergy label [non-AAL group]) were randomly selected for comparison. AALs were evaluated and classified as type A adverse drug reactions (ADRs; nonimmune mediated), type B ADRs (immune mediated), or of unknown type (3). Baseline demographics, transplant history, and infection-related admission data were collected. From the time of transplant until 12 months afterward, antibiotics administered during infection-related admissions and their duration of administration were recorded. Readmission, intensive-care unit (ICU) admission, Clostridium difficile infection (CDI), multidrug-resistant (MDR) organism isolation, and mortality rate were captured. An MDR organism was defined as a bacterium resistant to at least one agent in three or more antibiotic classes (4).Of 313 LTRs, 51 (16%) had Ն1 AAL. Females predominated in the AAL group (75% female versus 25% male; P ϭ 0.003), but there was no statistically significant differences in the rates of ICU admission and mortality between males and females (see Table S1 in the supplemental material). Seventy-seven AALs were recorded; of these, 23% (18/77) were type A ADRs, 66% were type B ADRs (51/77), and 10% (8/77) were of unknown type. Of the type A ADRs, 72% (13/18) were gastrointestinal upset, and of the type B ADRs, 6% (3/51) were severe cutaneous ADRs, 55% (28/51) were maculopapular exanthema, 35% (18/51) were anaphylaxis, urticaria, or angioedema, and 4% (2/51) were other reactions. The antibiotics implicated in AALs are demonstrated in Fig. 1

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Background Infliximab therapy may be associated with drug-induced liver injury (DILI), often resembling a drug-induced autoimmune hepatitis. However, the prevalence of DILI in patients receiving infliximab is unclear. Abnormal liver biochemistry is common in patients with inflammatory bowel disease (IBD) and definitive diagnosis may be difficult. The aim of this study was to describe the patterns of abnormal liver biochemistry in an IBD cohort. Methods In a retrospective cohort study of adult patients with IBD treated with infliximab through a single institution we used the Roussel Uclaf Causality Assessment Method (RUCAM) to evaluate liver biochemistry and possible DILI. All cases of abnormal liver biochemistry were ascribed a presumptive diagnosis from the electronic medical record. Results Fifty-seven of the 175 patients (149 Crohn's disease, 26 ulcerative colitis) had abnormal liver biochemistry. Of the 57 cases, one had highly probable, and 10 possible DILI due to infliximab. There were no significant differences regarding demographics, concomitant therapy/ disease, indication for infliximab or outcomes between patients with normal and abnormal liver biochemistry, except for higher baseline alanine transaminase and alkaline phosphatase in the abnormal biochemistry group (P<0.001). Multivariate logistic regression showed male sex (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.22-5.09; P=0.01) and background liver disease (OR 15.09, 95%CI 4.09-55.69; P<0.001) to be associated with the abnormal liver biochemistry group. Conclusions Abnormal liver biochemistry is common in IBD patients on infliximab. Patients who are male, or have abnormal pre-therapy liver biochemistry or background liver disease, are more likely to develop worsening liver biochemistry during infliximab therapy. RUCAM scoring may help identify true cases of DILI.

Background and study aims  Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods  Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017). Results  From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P  < 0.0001), and shorter average LoS (1 vs 9 days, P  < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions  The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.