Supporting quotations for clinician perceptions theme
| Subtheme | Supporting quotations |
| Necessity to protect patients | 1. “I mean she has already gone on meropenem. So, it might be that it was keeping something [infection] at bay. And then it has been stopped. And that infection has re-developed.” —P57, middle-grade trainee, hospital 3, VBI |
| 2. “I think a four days’ course of antibiotics is going to lead to resistance if anything because he’s not completed a full course […] In this situation there’s not really been a bug, so I think a seven-day minimum [course] would be appropriate.” —P22, middle-grade trainee, hospital 3, VBI | |
| 3. “Maybe they’ve got a minor infection, it will self-resolve without any antibiotics, but maybe [with antibiotics] you’ll get an extra day or so where the patient is now considered safe for discharge. And so, you’ve accelerated the discharge and so there’s a whole process of flowing the patient through the hospital and progressing them. And ultimately not exposing them to an environment in which they are at risk of actually picking up a nosocomial infection.” —P43, consultant, hospital 1, VBI | |
| Necessity to protect clinicians | 4. “One of the questions that I was grilled on in the Coroner’s court last Monday was ‘Why are we stopping antibiotics? If he had such a bad infection, why did we stop the antibiotics?’” —P28, consultant, hospital 1, FG |
| 5. “I don’t know if you’ve heard about the Sepsis Six? […] if you decided not to start antibiotics, I don’t know where you would stand, I don’t think you would have a leg to stand on at all.” —P10, consultant, hospital 2, FG | |
| Antibiotic-related concerns not prioritised | 6. “[…] when I have a patient, and the patient is deteriorating, I just focus on that patient. I don’t think, ‘What’s the impact of starting this or that antibiotic on the whole ecology of the unit?’ I don’t bother because, to be honest, my focus is that patient.” —P1, consultant, hospital 3, VBI |
| 7. “[…] we’re creating our own monster [antimicrobial resistance] because we’re throwing around antibiotics.” —P11, consultant, hospital 1, FG | |
| 8. “I’d want them to have antibiotics. Despite the fact that there is this theoretical risk of resistance.” —P36, consultant, hospital 2, VBI | |
| Being brave vs being burnt | 9. “It can be, sometimes, more helpful to start with a more focused [narrower spectrum] antibiotic rather than muddle the picture with empirical antibiotics. But that takes a certain amount of bravery.” —P3, early-career trainee, hospital 1, VBI |
| 10. “So, I, my gut feeling, so I’m 70% certain he doesn’t need antibiotics now.” —P6, consultant, hospital 3, VBI | |
| 11. “Maybe I’m not yet at the stage where I’d be brave enough to start nothing [no antibiotics]. I would like to be. I think we give far too many antibiotics. But I’m probably not at that stage yet. […] Probably, in this particular instance, I don’t think you’d be able to get away with not starting antibiotics at all. Because she’s become so unwell, she’s intubated. I think what makes you more brave in your decision-making is experience.” —P35, middle-grade trainee, hospital 2, VBI | |
| 12. “There’s definitely cases where you’re brave until you’re burnt and then you stop being brave. And you only have to have one, I had one recently where I just didn’t spot it as being sepsis and the guy died overnight.” —P48, consultant, hospital 1, FG |
FG, focus group; VBI, vignette-based interview.