PARROT: Penicillin Allergy, Antibiotic Resistance and Patient health OuTcomes

JARGON BUSTER: Antibiotic: A medicine used to treat infections caused by bacteria. Antibiotics work by killing bacteria. Antibiotic resistant bacteria: 'Superbugs like MRSA'. Bacteria that have changed so they are no longer killed by antibiotics. Antimicrobial resistance/AMR: A term used to describe the development of antibiotic resistant bacteria. Bloodstream Infection/BSI: A serious infection caused by bacteria in the blood. PARROT: Fellowship study's short name. Penicillins: A common group of antibiotics. Penicillin allergy/PenA: When your immune system reacts abnormally to penicillin, wrongly thinking it is harmful. BACKGROUND: Antibiotic resistant bacteria have a huge impact on patients and the NHS because infections involving these resistant bacteria mean our usual antibiotic treatments will not work as well. People who are affected take longer to get better from common infections and are more likely to die from serious infections e.g.bloodstream infections (BSI). This problem is often called AMR. AMR is caused by overuse and misuse of antibiotics. Penicillins are the first-choice treatment for many common infections. People who have Penicillin allergy/PenA are treated with different, non-penicillin antibiotics. People with PenA are typically prescribed more antibiotics overall, partly because the alternative antibiotics fail to clear the infection. Research has shown that although many people have PenA labels in their notes, most of these people (9 in 10) do not actually have a true allergy when they are tested by a specialist, which means antibiotics are being misused and overused. HEALTH NEED: PenA labels have been linked with 'superbugs', however the full impact of PenA on AMR is unknown. In particular the impact of PenA on AMR and health outcomes in patients treated for BSI and COVID-19 (both of which can cause life-threatening sepsis) is not known. We know that antibiotic use can affect the bacteria that normally live in our guts and mouths. These help us digest food and prevent infections. The more antibiotics are used, the more likely it is that these helpful bacteria are 'killed off', leading to harmful bacteria growing in their place. These harmful bacteria may be able to cause infections, or have genes that make them resistant to antibiotics, or both. See https://youtu.be/r_50QNX0-t0 AIM: To understand the links between PenA, AMR and patient health outcomes in order to improve antibiotic use. METHODS: PARROT is organised into three workstreams: Firstly, I will use a large collection of patient data provided by the PIONEER Health Data Research hub, who hold anonymised data on patients admitted hospital. This data will be used to see if PenA patients who have BSI are more likely to have AMR. Secondly, using data from the NIHR funded PEACH study which is investigating antibiotic use in patients with COVID-19, I will carry out a study to find out the effect of PenA on AMR and patient health outcomes in patients admitted with COVID-19. Thirdly, I will work with the ALABAMA trial, a NIHR-funded trial which aims to remove incorrect PenA labels through pencilling allergy testing. I will recruit ALABAMA trial participants, to carry out a study within a trial that will explore if removing incorrect PenA labels results in reduced AMR. PATIENT AND PUBLIC INVOLVEMENT (PPI): Jenny Boards (PPI lead contributor) has brought her 'PenA lived experience' to co-design PARROT, guiding simplification of the scientific language, and ensuring a patient benefit focus. DISSEMINATION: This research will benefit patients, healthcare workers and policymakers by providing the evidence to support better antibiotic prescribing and help limit AMR. It will tell us if removing incorrect PenA labels results in less AMR. Results will be shared through presentations at scientific meetings, publications in journals and a short video co-developed with PPI-contributors.