Surveillance of ICU - Acquired Infections National Feedback Report Risk Factor Indicators Year 2015

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1 Surveillance of ICU - Acquired Infections National Feedback Report Risk Factor Indicators Year 2015 Scientific Institute of Public Health Direction of Public Health and Surveillance National Surveillance of Hospital Infections (NSIH program) 14, Juliette Wytsmanstraat 1050 Brussels - Belgium Het project wordt financieel ondersteund door KB van 19 juni 2007 betreffende de vaststelling en de vereffening van het budget van financiële middelen van de ziekenhuizen Le projet est financièrement soutenu par AR du 19 juin 2007 relatif à la fixation et à la liquidation du budget des moyens financiers des hôpitaux Further information on this report: Mr. Karl Mertens Tel karl.mertens@wiv-isp.be

2 List of Tables 1 Missing Admission variables Admission Characteristics (a) Admission Characteristics (b) Admission Characteristics (c) Admission Characteristics (d) Daily Invasive Device exposure indicators Missing SOFA Scores Daily SOFA score indicators Daily SOFA score indicators Antibiotic Use Population (aggregated) Antibiotic Use Distribution (aggregated) Antibiotic Use (exhaustive) (a) Antibiotic Use (exhaustive) (b) Antibiotic Use (exhaustive) (c) Pneumonia and Admission Exposure (a) Pneumonia and Admission Exposure (b) Pneumonia and Admission Exposure (c) Pneumonia and Admission Exposure (d) Bloodstream Infection and Admission Exposure (a) Bloodstream Infection and Admission Exposure (b) Bloodstream Infection and Admission Exposure (c) Bloodstream Infection and Admission Exposure (d) Pneumonia and Invasive Device Exposure (a) Pneumonia and Invasive Device Exposure (b) Pneumonia and Invasive Device Exposure (c) Bloodstream Infection and Invasive Device Exposure (a) Bloodstream Infection and Invasive Device Exposure (b) Bloodstream Infection and Invasive Device Exposure (c) Pneumonia and SOFAscore (a) Pneumonia and SOFAscore (b) Bloodstream Infections and SOFAscore (a) Bloodstream Infections and SOFAscore (b) Pneumonia and Antibiotic Use Bloodstream Infection and Antibiotic Use Standardized Pneumonia and Bacteremia Rates Nosocomial Pneumonia and Bacteremia risk score distribution List of Figures 1 Evolution: SAPS II Score Median Evolution: Death / DNR (%) Evolution: Intubation days / 1000 patientdays Evolution: CVC days / 1000 patientdays Evolution: Any AB utilization days / 1000 patientdays Benchhmark: Standardized Pneumonia Ratio Benchhmark: Ventilator Associated Pneumonia versus Standardized Pneumonia Ratio Benchhmark: Standardized Bacteremia Ratio Benchhmark: Catheter Associated Bacteremia versus Standardized Bacteremia Ratio Scientific Institute Public Health, Brussels, 20 Apr :09:37 1

3 Table 1: Missing Admission variables variable L1 a L2 a Ls a Req a # a % a p10 p25 p50 p75 p90 discharge date from the ICU V 0 M discharge status V 0 R discharge date from the hospital V 0 O discharge status from the hospital V 0 O SAPS II score V 0 R APACHE II score V 0 O PRISM score V 0 O patient origin V 0 O type of admission V 0 R trauma V 0 R impaired immunity V 0 O antimicrobial treatment within 48h around admission (<>48h) V 0 R acute coronary care V a R surgery in 30 days before admission V a R surgery in 30 days before admission V a R Glasgow coma score, estimated V a O Glasgow coma score, measured V a O total patient variables V a O a l1= level 1 variable (denominator-based surveillance) ; l2= level 2 variable (patient-based surveillance) ; L2s= level 2 suboption (0=basic level 2 variables a=extra patient admission and day by day variables, b=central vascular catheter follow-up, c=antimicrobial treatment follow-up); Req: M=mandatory, R=Required, O=Optional #=number of missing variables; %=# / 100 eligible records Scientific Institute Public Health, Brussels, 20 Apr :09:37 2

4 Table 2: Admission Characteristics (a) patients LOS p50 a SAPSII p50 a Death/DNR % a # b % b agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 Age unknown Gender female male unknown SAPSII score unknown a LOS=median length of stay for patients admitted within this category; SAPSII=median SAPSII score for patients admitted within this category b #=number of admissions within category; %=#/100 total admissions Scientific Institute Public Health, Brussels, 20 Apr :09:37 3

5 Table 3: Admission Characteristics (b) patients LOS p50 a SAPSII p50 a Death/DNR % a # b % b agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 Apache Score < unknown Patient Origin other service other ICU community nursing home unknown Type of Admission medical scheduled surgical unscheduled surgical unknown a LOS=median length of stay for patients admitted within this category; SAPSII=median SAPSII score for patients admitted within this category b #=number of admissions within category; %=#/100 total admissions Scientific Institute Public Health, Brussels, 20 Apr :09:37 4

6 Table 4: Admission Characteristics (c) patients LOS p50 a SAPSII p50 a Death/DNR % a # b % b agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 Trauma no yes unknown Impaired Immunity no yes unknown Antibiotic Treatment no yes unknown a LOS=median length of stay for patients admitted within this category; SAPSII=median SAPSII score for patients admitted within this category b #=number of admissions within category; %=#/100 total admissions Scientific Institute Public Health, Brussels, 20 Apr :09:37 5

7 Table 5: Admission Characteristics (d) patients LOS p50 a SAPSII p50 a Death/DNR % a # b % b agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 agg p25 p50 p75 Acute Coronary Care no yes unknown Prior Surgery site no coronary other cardiac other thoracic other vascular abdominal neurosurgery other unknown a LOS=median length of stay for patients admitted within this category; SAPSII=median SAPSII score for patients admitted within this category b #=number of admissions within category; %=#/100 total admissions Scientific Institute Public Health, Brussels, 20 Apr :09:37 6

8 Table 6: Daily Invasive Device exposure indicators invasive device # a rate a agg a p10 p25 p50 p75 p90 Intubation days patients with Intubation days central vascular catheter days patients with central vascular catheter days urinary catheter days patients with urinary catheter days naso-oro intestinal tube days patients with naso-oro intestinal tube days naso-oro intestinal tube feeding days patients with naso-oro intestinal tube feeding days parenteral feeding days patients with parenteral feeding days invasive mechanical ventilation days patients with invasive mechanical ventilation days non-invasive mechanical ventilation days patients with non-invasive mechanical ventilation days tracheotomy intubation days patients with tracheotomy intubation days re-intubation days patients with re-intubation days a #=number of days or patients with device exposure; rate=#/1000 patientdays (days); rate=#/100 admissions (patients) Scientific Institute Public Health, Brussels, 20 Apr :09:37 7

9 Table 7: Missing SOFA Scores variable L1 a L2 a Ls a Req a # a % a p10 p25 p50 p75 p90 sofa score, cns V a R sofa score, respiration V a R sofa score, coagulation V a R sofa score, cardio V a R sofa score, kidney V a R sofa score, liver V a R total sofa variables V a O a l1= level 1 variable (denominator-based surveillance) ; l2= level 2 variable (patient-based surveillance) ; L2s= level 2 suboption (0=basic level 2 variables a=extra patient admission and day by day variables, b=central vascular catheter follow-up, c=antimicrobial treatment follow-up); Req: M=mandatory, R=Required, O=Optional #=number of missing variables; %=# / 100 eligible records Scientific Institute Public Health, Brussels, 20 Apr :09:37 8

10 Table 8: Daily SOFA score indicators # a agg b p10 b p25 b p50 b p75 b p90 b CNS score any scores Respiratory score any scores Coagulation score any scores Cardiovacular score any scores a #=number of patientdays; 0/4/any=# of days with SOFA score=0/4/any b 0/4=% of days with SOFA score=0/4 among days with any SOFA score; any=% of days with any SOFA score among total patientdays; scores=median score for SOFA component; agg= value obtained when pooling all participating units; p=percentiles for the distribution of participating units; Scientific Institute Public Health, Brussels, 20 Apr :09:37 9

11 Table 9: Daily SOFA score indicators # a agg b p10 b p25 b p50 b p75 b p90 b Renal score any scores Liver score any scores Total score 0/ / / /max any scores a #=number of patientdays; 0/4/any=# of days with SOFA score=0/4/any b 0/4=% of days with SOFA score=0/4 among days with any SOFA score; any=% of days with any SOFA score among total patientdays; scores=median score for SOFA component; agg= value obtained when pooling all participating units; p=percentiles for the distribution of participating units; Scientific Institute Public Health, Brussels, 20 Apr :09:37 10

12 Table 10: Antibiotic Use Population (aggregated) Patients, # a Patientdays, # a agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 patients with AB use units with AB use a Patients, #=number of patients; Patientdays, #=number of patientdays; agg=aggregated over all participating units; p10-p90=percentile of distribution of participating units Scientific Institute Public Health, Brussels, 20 Apr :09:37 11

13 Table 11: Antibiotic Use Distribution (aggregated) # a % a incd a agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 Total AB days AB days with SDD use AB days with Profylactic use AB days with Empirical use AB days with Microorganism known AB days with Antibiogram known a #=number of Antibotic days with particular use; %=# AB days/100 total AB days; incd=# AB days/1000 patientdays of units with AB use; agg=aggregated over all participating units; p10-p90=percentile of distribution of participating units Scientific Institute Public Health, Brussels, 20 Apr :09:37 12

14 Table 12: Antibiotic Use (exhaustive) (a) Antibiotic pats patdays Antibiotic days, # a # # T S P E M A all J01A TETRACYCLINES J01AA Tetracyclines J01AA02 Doxycycline J01AA07 Tetracycline J01C PENICILLINS J01CA Penicillins extended spectrum J01CA01 Ampicillin J01CA04 Amoxicillin J01CA12 Piperacillin J01CA17 Temocillin J01CF SS-lactamase resist. penicillins J01CF04 Oxacillin J01CF05 Flucloxacillin J01CG SS-lactamase inhibitors J01CG02 Tazobactam J01CR SS-lactam + SS-lactamase inhibitor J01CR01 Ampicillin + sulbactam J01CR02 Amoxicillin + clavulanic acid J01CR05 Piperacilline + Tazobactam J01D OTH. SS-LACTAM AB,INCL.CEPHALOSP J01DA Cephalosporins J01DA04 Cefazolin J01DA06 Cefuroxime J01DA10 Cefotaxime J01DA11 Ceftazidime J01DA13 Ceftriaxone J01DA24 Cefepime J01DF Monobactams J01DF01 Aztreonam J01DH Carbapenems J01DH02 Meropenem a T=total use; S=SDD use; P=Profylactic use; E=Empirical use; M=Microorganism known; A=Antibogram known Scientific Institute Public Health, Brussels, 20 Apr :09:37 13

15 Table 13: Antibiotic Use (exhaustive) (b) Antibiotic pats patdays Antibiotic days, # a # # T S P E M A J01E SULFONAMIDES AND COMBINATIONS J01EA Trimethoprim J01EA01 Trimethoprim J01EE Sulfonamides + trimethoprim + deriv J01EE01 Sulfamethoxazole+T.(cotrimoxaz.) J01F MACROLIDES AND LINCOSAMIDES J01FA Macrolides + Synergistins J01FA01 Erythromycin J01FA09 Clarithromycin J01FF Lincosamides J01FF01 Clindamycin J01G AMINOGLYCOSIDE ANTIBACTERIALS J01GB Aminoglycosides other than strep J01GB03 Gentamicin J01GB06 Amikacin J01M QUINOLONE ANTIBACTERIALS J01MA Fluoroquinolones J01MA02 Ciprofloxacin J01MA06 Norfloxacin J01MA12 Levofloxacin J01MA14 Moxifloxacin a T=total use; S=SDD use; P=Profylactic use; E=Empirical use; M=Microorganism known; A=Antibiogram known Table 14: Antibiotic Use (exhaustive) (c) Antibiotic pats patdays Antibiotic days, # a # # T S P E M A J01X OTHER ANTIBACTERIALS J01XA Glycopeptide antibacterials J01XA01 Vancomycin J01XA02 Teicoplanin J01XB Polymyxins J01XB01 Colistin J01XB02 Polymyxin B J01XD Imidazole derivatives J01XD01 Metronidazole J01XX08 Linezolid J02A ANTIMYCOTICS FOR SYSTEMIC USE J02AA Antifungal antibiotics J02AB Imidazole antimycotics J02AB02 Ketoconazole J02AC Triazole derivative antimycotics J02AC01 Fluconazole J02AX Other systemic antimycotics J02AX04 Caspofungin J04A TREATMENT OF TUBERCULOSIS J04AB Antimycobacterial antibiotics J04AB02 Rifampicin a T=total use; S=SDD use; P=Profylactic use; E=Empirical use; M=Microorganism known; A=Antibogram known Scientific Institute Public Health, Brussels, 20 Apr :09:37 14

16 Table 15: Pneumonia and Admission Exposure (a) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Age unknown Gender female male unknown SAPSII score unknown a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 15

17 Table 16: Pneumonia and Admission Exposure (b) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 APACHE score < unknown Patient Origin other service other ICU community nursing home unknown Type of Admission medical scheduled surgi cal unscheduled surgical unknown a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 16

18 Table 17: Pneumonia and Admission Exposure (c) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Trauma no yes unknown Impaired Immunity no yes unknown Antibiotic Treatment no yes unknown a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 17

19 Table 18: Pneumonia and Admission Exposure (d) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Acute Coronary Care no yes unknown Prior Surgery site no coronary other cardiac other thoracic other vascular abdominal neurosurgery other unknown a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 18

20 Table 19: Bloodstream Infection and Admission Exposure (a) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Age unknown Gender female male unknown SAPSII score unknown a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 19

21 Table 20: Bloodstream Infection and Admission Exposure (b) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 APACHE score < unknown Patient Origin other service other ICU community nursing home unknown Type of Admission medical scheduled surgical unscheduled surgical unknown a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 20

22 Table 21: Bloodstream Infection and Admission Exposure (c) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Trauma no yes unknown Impaired Immunity no yes unknown Antibiotic Treatment no yes unknown a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 21

23 Table 22: Bloodstream Infection and Admission Exposure (d) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Acute Coronary Care no yes unknown Prior Surgery site no coronary other cardiac other thoracic other vascular abdominal neurosurgery other unknown a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 22

24 Table 23: Pneumonia and Invasive Device Exposure (a) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Intubation / / >= Central Vascular Catheter / / >= Urinary Catheter / / >= a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 23

25 Table 24: Pneumonia and Invasive Device Exposure (b) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Naso Oro Intestinal Tube without feeding / / >= Naso Oro Intestinal Tube with feeding / / >= Parenteral Nutrition / / >= a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 24

26 Table 25: Pneumonia and Invasive Device Exposure (c) pats a patdays a NP a IAP a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Invasive Mechanical Ventilation / / >= Non-Invasive Mechanical Ventilation / / >= Tracheotomy Intubation / / >= a pats=patients patdays=patient days NP=Nosocomial Pneumonia; IAP=Intubation Associated NP b #=crude number; pats/patdays %=percentage of total pats/patdays; NP %=# NP /100 patients; NP incd = # NP / 1000 patientdays; IAP incd = # NP / 1000 intubation days (before 1st NP); IUR=Intubation Utilization Rate, intubation days / 1000 patientdays Scientific Institute Public Health, Brussels, 20 Apr :09:37 25

27 Table 26: Bloodstream Infection and Invasive Device Exposure (a) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Intubation / / >= Central Vascular Catheter / / >= Urinary Catheter / / >= a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 26

28 Table 27: Bloodstream Infection and Invasive Device Exposure (b) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Naso Oro Intestinal Tube without feeding / / >= Naso Oro Intestinal Tube with feeding / / >= Parenteral Nutrition / / >= a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 27

29 Table 28: Bloodstream Infection and Invasive Device Exposure (c) pats a patdays a NB a CAB a # b % b # b % b # b % b incd b # b incd b agg agg agg agg agg agg p10 p25 p50 p75 p90 agg p10 p25 p50 p75 p90 agg agg p10 p25 p50 p75 p90 Invasive Mechanical Ventilation / / >= Non-Invasive Mechanical Ventilation / / >= Tracheotomy Intubation / / >= a pats=patients patdays=patient days NB=Nosocomial Bacteremia; CAB=Catheter Associated NB b #=crude number; pats/patdays %=percentage of total pats/patdays; NB %=# NB /100 patients; NB incd = # NB / 1000 patientdays; CAB incd = # NP / 1000 Catheter days (before 1st NB); Scientific Institute Public Health, Brussels, 20 Apr :09:37 28

08:00 Anti-Infective Agents 08:00. Anti-Infective Agents

08:00 Anti-Infective Agents 08:00. Anti-Infective Agents Anti-Infective Agents Anti-Infective Agents 08:08 ANTHELMINTICS MEBENDAZOLE 100 MG ORAL CHEWABLE TABLET 00000556734 VERMOX JAI 5.0300 08:12.02 (AMINOGLYCOSIDES) GENTAMICIN SULFATE 40 MG / ML (BASE) INJECTION