Please select the eligibility criteria that correspond to the clinical trial below.
Title: Evaluation of Antimicrobial Use and Time of Treatment of Nosocomial Sepsis Comparing Polymerase Chain Reaction (PCR) in Real Time Multiplex to the Conventional Blood Culture for Etiologic Agents Identification. Randomized Clinical Trial.
Brief Summary: The objective of this study is to evaluate the consumption of antimicrobial therapy in patients comparing a rapid molecular test (PCR in Real-Time Multiplex) with blood cultures to identify the etiological agents of sepsis.


Options:
A: Inclusion Criteria:

* Age≥ 18 years
* Written signed and dated inform consent
* First time with fever observed in a neutropenic patient
* Severe sepsis in a patient hospitalized in ICU
* Suspicion of infective endocarditis
* Microbial investigation from Monday to Friday

Exclusion Criteria:

* Not affiliated to Health Insurance (social security)
* Included in another interventional trial testing microbial DNA detection during the time "without Septifast®"
* Included in another clinical trial for which the clinician assumes that it will not be possible to prescribe an anti-infectious therapy adequately to microbial detection in the blood
* Patient previously included in the protocol
* Sepsis with a microbial diagnosis
B: Inclusion Criteria:

* Patient 18 or more years old
* Patient staying more than 48 hours in hospital
* Patient with clinical suspicion of infection and presenting at leat two of the following criteria:temperature \> 38oC or \< 36oC, heart rate \> 90 beats/minute, respiratory rate \> 20 breaths/minute or PaCO2 \< 32 mmHg or leukocytosis \>12 000/μl or leukopenia \<4000/μl or normal white blood cell count with \>10% immature forms
* Patient or responsible able to provide informed consent

Exclusion Criteria:

* Patient submitted to cardiovascular surgery in the last fifteen days
* Patient or responsible are not able to provide informed consent
C: Inclusion Criteria:

* Positive blood culture with Gram stain showing GNB identified during local laboratory business hours.

Exclusion Criteria:

* Identification of GNB outside of local laboratory business hours (e.g. whenever laboratories are staffed to perform both rapid testing and routine testing)
* Positive blood culture for GNB at the same institution within prior 7 days (if known at the time of randomization).
* Deceased at the time of randomization.
* GNB plus gram-positive organism, gram-negative cocci, and/or yeast detected on Gram stain
* Previous enrollment in this study
* No Minnesota research authorization (Rochester site only)
D: Inclusion Criteria:

* ICU patients ≥18 years.
* With a suspected pneumonia (according to CPIS definition), primary blood-stream infection (according to CDC definition), and/or urinary tract infection (according to IDSA Guidelines).
* And presence of ≥2 GNB/field on direct examination of a respiratory sample (quantitative bronchial aspirate with an available volume ≥ 1mL), urinary sample or blood culture.
* Leading to an empirical carbapenem prescription, not administered for more than 6 hours when considering the inclusion of the patient.
* Written informed consent signed by the patient / the trustworthy person / the next-of-kin / close relative, or inclusion in case of emergency and written informed consent will been signed by the patient as soon as possible.
* Patients affiliated to French social security.

Exclusion Criteria:

* Pregnancy.
* Allergy to beta-lactams.
* Patients already treated with ongoing carbapenems for another documented infection, blocking carbapenem de-escalation.
* Patients included in another interventional study.
* Patients in whom a procedure of withdrawing life-sustaining treatment was decided before inclusion.
* Moribund patients.
* Patients with aplasia.
* Patients under tutorship/curatorship or patient deprived of freedom

Answer: B