Table 3. Participant vignettes: three example participants discussed at the consensus meeting, shown with final decisions on patient classification.

Participant-1 E.coli S: ceftriaxone, chloramphenicol, gentamicin, ciprofloxacin, meropenem R: ampicillin, cotrimoxazole Classification: Definite Gram-negative sepsis	26 year old female HIV negative, normally fit and well. 2 weeks postpartum. Caesarian section done at Queen Elizabeth Central Hospital. Unwell for 10 days post-operatively: abdominal pain, and fevers. Admission: Temperature 40.0°C. SIRS = Yes Recruitment Day 7: Temperature 37.0°C. SIRS= Yes Wound clean. No urinary catheters. Urine dipstick negative. Antibiotics: 9 days ceftriaxone, 5 days ciprofloxacin Bloods Day 7: WCC 8.3 x10 9 L -1, CRP 91 mg/L, Lactate 2.6, Outcome: Discharged alive
Participant-2 E.coli S: ceftriaxone, chloramphenicol, gentamicin, ciprofloxacin, meropenem R: ampicillin, cotrimoxazole Classification: Definite Gram-negative sepsis	72 year old male HIV positive, on ART 10 years. Benign prostatic hyperplasia. Unwell for 3–4 weeks: confusion, cough, weight loss, lethargy. Pre-hospital: Co-amoxiclav and azithromycin within 1 month of admission. Week 2 TB Treatment Admission: Temperature 35.7°C, GCS 10. SIRS = Yes Recruitment Day 5: Temperature 37.5°C. SIRS = No Bloods Day 5: CD4 158 μL -1, WCC 26.0 x10 9 L -1,CRP >120mg L -1, lactate 3.4mmol L -1, creatinine 862mmol L -1 Antibiotics: Ceftriaxone 24 hours Outcome: Died in hospital
Participant 3 E.coli S: chloramphenicol, gentamicin, amikacin, meropenem, co-amoxiclav R: ceftriaxone, ampicillin, cotrimoxazole, ciprofloxacin Classification: Possible Gram-negative sepsis	32 year old woman, HIV positive, ART 2 years. Mechanical fall into drain, pain in hip and hx of fevers 24 hours later. Associated headache and diarrhoea. Presented to Emergency Department after 5 days, had blood culture and outpatient follow-up arranged. No vital signs available on admission. Discharged on no antibiotics. Bloods Day 6: WCC 6.3 x10 9 L -1, creatinine 39mmol L -1,CD4 847μL -1, lactate 2.6mmol L -1, CRP 36mg L -1, urine dip negative Repeat blood culture on Day 6 = negative, no antibiotics in between Antibiotics: one dose of gentamicin on day 6, then discharged on nothing. Outcome: Discharged alive

Abbreviations: SIRS, systemic inflammatory response syndrome; ART, antiretroviral therapy; WCC, white cell count; CRP, C-reactive protein