• Adults (≥ 18 years)

• Hospital-acquired sepsis (according to sepsis 3.0 definitions) :

‣ Patient hospitalized for more than 48 hours OR Patient discharged less than 48 hours ago

⁃ AND sepsis diagnosed within the last 24 hours

• One of the following risk factors for gram negative multidrug resistant pathogens:

‣ Prior intravenous antibiotic use within 7 days prior to sepsis onset with the exception of antibiotic effective only against Gram-positive bacteria, penicillin A and macrolides

⁃ Prolonged hospital stay (≥ 15 days of hospitalization) within 3 months prior to sepsis onset Prolonged mechanical ventilation (≥ 5 days on mechanical ventilation) within 3 months prior to sepsis onset

⁃ Patients with indwelling devices (dialysis access lines, intravascular lines, urinary catheter, endotracheal or tracheostomy tube, gastrostomy or jejunostomy feeding tube)

⁃ Patients known to be infected, colonized or carriers of MDR gram negative bacteria within 3 months prior to sepsis onset

⁃ Exposure to an antibiotic (amoxicillin-clavulanic acid, C2G, C3G, fluoroquinolones) within 3 months prior to sepsis onset

⁃ A trip abroad to known geographical areas at risk (in particular the Indian subcontinent, South-East Asia, the Middle East and North Africa, the Mediterranean Basin) within 3 months prior to sepsis onset

⁃ A functional or organic abnormality of the urinary tract in case of urinary tract infection.

• Appropriate bacteriological sampling performed before starting antimicrobial therapy

• Expected stay in ICU of more than 3 days