Table 2.

Themes and illustrative quotations identified from semi-structured interviews of 30 inpatient physicians

Category	Case vignette	Illustrative quotation
1. Lack of awareness of specific guideline-recommendations	SSTI	1. “[Treating for] methicillin susceptible [S. aureus] without MRSA? Oh, oh, wow….[and] not doing any gram negative coverage? I guess I am most dis-comfortable with that, but if that’s the guideline [recommendation], yes, I will probably start following it” (8, attending).
	ASB	2. “I still think that he has a UTI [urinary tract infection], even though he doesn’t necessarily have symptoms, because he was catheterized for so long. I also know after you reach a certain age, we generally treat you even though you don’t necessarily have symptoms just because of all the risks associated with having bacteria in your urine” (29, resident).
2. Tension between adhering to guidelines and individualizing patient care	SSTI	3. “If he had a known history of MRSA, if he had something else like…a temporary dialysis line…or prosthetic joint or something else that if he were to get bacteremic with MRSA, it would cause him more operations and significant morbidity…[In that case], I might add vancomycin to his regimen from the beginning” (12, resident).
	HAP	4. “He has only one lung because he had part of his lung taken out. So, anyway, part of a lung taken out, and he’s got a new infiltrate on his x-ray, and he’s got all the risk factors for pneumonia, so I would say generally I would leave him on antibiotics, but cut down” (5, attending). 5. “I would be concerned, especially since the patient was febrile. He did have a new infiltrate, and he seemed to have gotten better on antibiotics. I would definitely take it [the guideline-recommendation] into consideration, but I would probably go ahead and give a course of oral antibiotics” (6, attending).
	ASB	6.“I would say this is a UTI. I’m sure the guidelines are going to say ‘no,’ but since he was having retention and it wasn’t a urine [culture] obtained from him having a Foley, I have less comfort calling it colonization. I would say that it is probably an infection. You don’t see a lot of fevers in just a bladder infection” (25, attending).
3. Skepticism of guideline recommendations	SSTI	7. “My big concern is methicillin-resistant Staph aureus (MRSA)…I think personally I have some concern about not covering for MRSA” (17, attending).
	HAP	8. “Those are the guidelines, so I mean it is agreeable if there are studies that back it up. It is not something I feel that great about, but I could trial them off antibiotics and see how they do” (14, resident). 9. “I guess I would have to look more at the studies that led to the recommendations…I don’t know that I would stop antibiotics completely because of how sick he was” (29, resident).
	ASB	10. “They [the guidelines] are tough to swallow, but we follow them because that is what the evidence shows. A lot of people would be very, very tempted to treat this” (19, attending). 11. “A guy has a catheter in for a month and has a ton of white cells in his urine and is growing something that is clearly pathogenic: he needs treatment. I do not care what the guidelines say” (7, attending).