Are antimicrobial stewardship and sepsis awareness competing goals?

Antimicrobial resistance (AMR) has emerged as one of the most significant threats to population health of recent times. It is estimated that its associated mortality could reach 10 million by 2050. Availability of effective antimicrobial prophylaxis is essential to allow many routine surgical and obstetric procedures to be performed safely. Reducing unnecessary antimicrobial use is integral to controlling the spread of AMR. As awareness of the need for judicious antimicrobial prescribing has grown, so has recognition of the importance of early diagnosis and management of sepsis, with high profile media reporting of selected cases, often involving children. Early administration of antibiotics to improve outcomes from sepsis conflicts, in part, with a drive to reduce antimicrobial prescribing. Previous research has suggested that AMR is often perceived as a distant and theoretical threat that has little personal impact, which may in part be related to how it is framed in news media. There is no evidence about how reporting of sepsis in children impacts on public understandings about antibiotic use. This PhD aims to better understand how the risks of antimicrobial resistance and sepsis are constructed in the popular news and how these impact on the attitudes and behaviour of the public, as parents and carers. Content analysis of 616 articles from 6 national newspapers published between 1988 and 2018 demonstrated key differences in the way AMR and sepsis are framed. AMR is framed predominantly according to its potential impact on future global health. Its causes and solutions are presented as complex and dependent on co-ordinated actions between policymakers and the healthcare, farming and pharmaceutical industries. In contrast, sepsis is framed as an issue whose drivers lie predominantly within the healthcare sector and whose main solution is better awareness. The use of personalised narratives about individuals affected by sepsis increases its relevance and accessibility for the public. Thematic analysis of a subset of articles demonstrated that failings in the health service were portrayed as the cause of avoidable deaths in children, often through failure to prescribe timely antibiotics, with parents positioned as advocates for their children. Exploration of these themes in 20 focus groups with 84 parents, carers and individuals with lived experience of sepsis demonstrated that decisions about when to seek health advice had to be balanced against a perceived moral duty to avoid placing excessive demands on healthcare resources. Health professionals were frequently perceived to be ambivalent about the need for antibiotics, with parent preference often influencing decisions. Few participants had direct experience of AMR, which was widely perceived to be a risk confined to individuals who use antibiotics inappropriately. There is a need to align messages about the complex interplay between AMR, sepsis and antimicrobial use. Personal narratives about individuals affected by AMR, similar to those used in sepsis awareness campaigns, may increase accessibility of public health messaging about preserving the efficacy of antibiotics