{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:53:40Z","timestamp":1790970820478,"version":"4.1.0"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["RP-PG-0514-20018"],"award-info":[{"award-number":["RP-PG-0514-20018"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Rapid molecular diagnostic tests improve antimicrobial stewardship (AMS) by facilitating earlier refinement of antimicrobial therapy. The INHALE trial tested the application of the BioFire FilmArray Pneumonia Panel (Pneumonia Panel) for antibiotic prescribing for hospital-acquired and ventilator-associated pneumonias (HAP\/VAP) in UK intensive care units (ICUs). We report a behavioral study embedded within the INHALE trial examining clinicians\u2019 perceptions of using these tests. Semi-structured interviews were conducted with 20 ICU clinicians after using the Pneumonia Panel to manage suspected HAP\/VAP. Thematic analysis identified factors reinforcing perceptions of the necessity to modify antibiotic prescribing in accordance with test results and doubts\/concerns about doing so. While most acknowledged the importance of AMS, the test\u2019s impact on prescribing decisions was limited. Concerns about potential consequences of undertreatment to the patient and prescriber were often more salient than AMS, sometimes leading to \u201cjust-in-case\u201d antibiotic prescriptions. Test results indicating a broad-spectrum antibiotic were unnecessary often failed to influence clinicians to avoid an initial prescription or de-escalate antibiotics early as they considered their use to be necessary to protect the patient and themselves, \u201cerring on the side of caution.\u201d Some clinicians described cases where antibiotics would be prescribed for a sick patient regardless of test results because, in their opinion, it fits with the clinical picture\u2014\u201ctreating the patient, not the result.\u201d Our findings illustrate a tension between prescribing guidelines and clinicians\u2019 \u201cmindlines,\u201d characterized by previous experiences. This highlights the need for a \u201ctechnology plus\u201d approach, recognizing the challenges clinicians face when applying technological solutions to patient care.<\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>Rapid molecular diagnostic tests for pathogens and resistance genes may improve antibiotic-prescribing decisions and stewardship. However, clinicians\u2019 desire to protect their patients with antibiotics often overrides more distal concerns about possible resistance selection, limiting the application of these tests in practice. Findings underscore the challenge of changing prescribing decisions based on technical results or guidelines, highlighting factors such as clinicians\u2019 previous experience and \u201cknowledge in practice\u201d as more proximal drivers of these decisions. Implementation strategies for technological solutions to antimicrobial resistance must be \u201cbehaviorally intelligent,\u201d recognizing the challenges facing clinicians when making \u201clife or death\u201d prescribing decisions.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                      <jats:title>CLINICAL TRIALS<\/jats:title>\n                      <jats:p>\n                        This study is registered with ISRCTN as\n                        <jats:related-object xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" document-id=\"ISRCTN16483855\" document-id-type=\"clinical-trial-number\" source-id=\"ISRCTN\" source-id-type=\"registry-name\" source-type=\"clinical-trials-registry\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN16483855\">ISRCTN16483855<\/jats:related-object>\n                        .\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01156-24","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T08:25:08Z","timestamp":1738743908000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":16,"title":["Guidelines vs mindlines: a qualitative investigation of how clinicians\u2019 beliefs influence the application of rapid molecular diagnostics in intensive care"],"prefix":"10.1128","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2396-9028","authenticated-orcid":true,"given":"Sarah-Jane F.","family":"Stewart","sequence":"first","affiliation":[{"name":"School of Pharmacy, University College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-496X","authenticated-orcid":false,"given":"Alyssa M.","family":"Pandolfo","sequence":"additional","affiliation":[{"name":"School of Pharmacy, 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Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3068-8438","authenticated-orcid":false,"given":"Rob","family":"Horne","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the INHALE WP4 Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie 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