Clinicians' decision-making about broad-spectrum antibiotic prescribing for suspected maternal sepsis during...

Sepsis management and antimicrobial resistance (AMR) are linked priorities. Early identification and treatment of sepsis with broad-spectrum antibiotics are key to reducing morbidity and mortality. We aimed to investigate clinicians' decision-making about broad-spectrum antibiotics for suspected maternal sepsis in women admitted to hospital for childbirth, to identify if, how and why overtreatment may occur.

Qualitative study. Semistructured interviews were conducted online, transcribed verbatim, coded in MAXQDA and analysed using the thematic Framework Approach.

National Health Service (NHS) in England, Scotland and Wales, March-June 2024.

24 clinicians, purposively sampled for representation from relevant professions with roles in decision-making (n=15 obstetricians; n=4 anaesthetists; n=3 midwives; n=2 microbiologists).

Participants report increasing numbers of women in labour are being prescribed broad-spectrum antibiotics for suspected maternal sepsis per guidelines. Fear of missing sepsis, absence of evidence about sepsis during labour and beliefs about antibiotic use informed clinicians' views, impacting workloads and women's experiences. 9/24 participants said overtreatment is a problem; 21/24 believed overtreatment occurs. Clinicians' beliefs, views and experiences are reported in three themes that provide a framework to explain how clinicians navigate guidelines including; why overtreatment can occur (Theme 1: The sepsis guideline is more than a guideline); how decisions to prescribe broad-spectrum antibiotics during labour are made (Theme 2: Trying to balance the whole picture) and where clinicians' think the bigger picture problems lie (Theme 3: If we continue down this path where might we be). The framework encapsulates clinicians' tacit knowledge governing decision-making and guideline use.

Clinicians link priorities for sepsis management and AMR, but antimicrobial stewardship comes second to concerns about missing sepsis in high-stakes maternity care. Overtreatment may be inevitable until better evidence to support decision-making for suspected maternal sepsis and point-of-care diagnostic tests for women in labour exist and are embedded in clinical guidelines and clinicians' mindlines.