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Table 4 Themes, subthemes and illustrative quotes

From: Hospital physicians’ experiences with procalcitonin – implications for antimicrobial stewardship; a qualitative study

Example quotes (informant number, clinicians’ years of experience) Subtheme Theme
My experience is that no one can actually say something certain about it (PCT). We use it and it guides us to some degree (…) but we don’t trust it 100% (R10, 16y)
It (PCT) is possibly indicated in several cases, but I don’t know them, so I think more knowledge about it would be effective (R14, 1y)
What you don’t use you don’t get good at; I see up to 100 CRP values every day so of course I can interpret CRP, while I encounter a PCT maybe only twice a week (R2, 18y)
Unsure of use Knowledge gap
When I get the result, I have no clue what it means. Then I ask colleagues, and they just “no, we don’t quite know what it means, don’t know if we can trust it, don’t know whether it increases or decreases in certain infections” (R5, 4y)
If someone had informed us how to interpret the (PCT) results for this patient group (cancer), it would of course have been a great help and I believe it would have made us a little more confident when using the test (R1, 12y)
Unsure of interpretation
I am not sure I would trust PCT in all diagnoses. The other day in geriatrics there was a lady with a HUGE intra-abdominal abscess, she had a PCT which was 0.25, which isn’t much (R11, 22y)
I’ve gotten surprised once in a while when I’ve used PCT e.g. on patients receiving immunotherapy; they are admitted with suspected infection, but it is actually adverse effects of the immunotherapy and PCT turns out really high, which is very confusing as there are no bacteria involved. (R5, 4y)
Trustworthiness
If I document that the patient has (increased) CRP but the PCT is only 0.27, he has no fever or other clinical signs of infection, I can quit antibiotics, − it helps me to be legally sound with regard to that decision (R8, 23y)
Very many patients get antibiotics “just in case”, as we say, but after we got PCT; it is absolutely a decision aid that helps us being “brave enough” to stop antibiotics or to not start antibiotics. (R4, 25y)
I think it is most useful to give backing in a decision. (R10, 16y)
Support decisions Diagnostic value
She had a CRP at 300 and high fever and all sepsis criteria, she also had an increased PCT, but it didn’t matter, she would have gotten antibiotics either way. (R13, 4y)
If I am quite convinced it is not an infection, but request a PCT and it turns out positive, I dismiss it and say like “no, I don’t think it is an infection’ and base my decision on the clinical picture (R5, 4y)
The clinical picture was already enough for us to continue antibiotics (despite of low PCT), we would never stop antibiotics on that clinical appearance (septic cancer patient) (R6, 4y)
Clinical evaluation most important