Potencialidades e limitações da Rede Sentinela para o aperfeiçoamento do monitoramento pós-comercialização/pós-uso de produtos sob vigilância sanitária adotado pela Anvisa

Introduction: Hospitals are essential for the universal coverage of any health system, as well as sources of  valuable information on adverse events and technical complaints of products subjects to health surveillance. Objective: To identify the potentialities and limitations of the Sentinel Network to improve post-marketing/post-use monitoring of products subject to health surveillance adopted by Anvisa. Method: A descriptive quantitative study that used data from a national administrative survey applied to the Sentinel Network, which was conducted between August 4 and September 2, 2021, by the Anvisa. Data were collected using an electronic structured  questionnaire. Statistical analyzes were performed in the Gretl-2022a software, including the calculation of absolute and relative frequencies, medians, and interquartile ranges. Results: A response rate of 69.1% (181/262) was obtained. Among the potentialities, the following stand out: acting as a center for study, teaching, and research of health establishments (n = 145; 80.1%), presence of implanted electronic medical records (n = 142; 78.4%) and the development of initiatives focused on innovation involving risk management of health products (n = 94; 52.0%). As one of the limitations, health establishments that do not have any current excellence/quality certifications predominate (n = 104; 57.5%). Conclusions: The Sentinel Network has  several potentialities and limitations that affect the post-marketing/post-use monitoring of products subject to  health surveillance. Identifying them, as was the objective of this study, demonstrates the need to promote actions that offer the possibility of expanding the potentialities and mitigate the limiting factors to the improvement of post-marketing/post-use monitoring adopted by Anvisa.Introdução: Os hospitais são essenciais para a cobertura universal de qualquer sistema de saúde, bem como são fontes de informações valiosas sobre eventos adversos e queixas técnicas de produtos sob vigilância sanitária. Objetivo: Identificar as potencialidades e limitações da Rede Sentinela para o aperfeiçoamento do monitoramento pós-comercialização/pós-uso de produtos sob vigilância sanitária adotado pela Anvisa. Método: Estudo descritivo quantitativo que utilizou dados de levantamento administrativo nacional aplicado à Rede Sentinela realizado entre 4 de agosto e 2 de setembro de 2021 pela Anvisa. Os dados foram coletados por meio de questionário estruturado eletrônico. As análises estatísticas foram executadas no software Gretl-2022a, compreendendo o cálculo das frequências absoluta e relativa, medianas e  intervalos interquartis. Resultados: Obteve-se uma taxa de resposta de 69,1% (181/262). Dentre as potencialidades, destacam-se: a atuação como centro de estudo, ensino e pesquisa dos estabelecimentos de saúde (n = 145; 80,1%), a presença de prontuário eletrônico implantado (n = 142; 78,4%) e o desenvolvimento de iniciativas voltadas para a inovação envolvendo a gestão de risco de produtos de saúde (n = 94; 52,0%). Como uma das limitações,   predominam os estabelecimentos de saúde que não possuem quaisquer certificações de excelência/qualidade vigentes (n = 104; 57,5%). Conclusões: A Rede Sentinela apresenta várias potencialidades e limitações que afetam o monitoramento pós-comercialização/pós-uso de produtos sob vigilância sanitária. Identificá-las, como foi o objetivo deste estudo, demonstra a necessidade de fomentar ações que ofereçam a possibilidade de ampliar as potencialidades e mitigar os fatores limitantes ao aperfeiçoamento do  monitoramento pós-comercialização/pós-uso adotado pela Anvisa

Molecular investigation of isolates from a multistate polymicrobial outbreak associated with contaminated total parenteral nutrition in Brazil

Background: Between November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of Total Parenteral Nutrition (TPN) and/or calcium gluconate (CG) were reported in four Brazilian states. Methods: We analyzed 73 bacterial isolates from four states: 45 from blood, 25 from TPN and three from CG, originally identified as Acinetobacter baumannii, Rhizobium radiobacter, Pantoea sp. or Enterobacteriaceae using molecular methods. Results: The first two bacterial species were confirmed while the third group of species could not be identified using standard identification protocols. These isolates were subsequently identified by Multi-Locus Sequence Analysis as Phytobacter diazotrophicus, a species related to strains from similar outbreaks in the United States in the 1970’s. Within each species, TPN and blood isolates proved to be clonal, whereas the R. radiobacter isolates retrieved from CG were found to be unrelated. Conclusion: This is the first report of a three-species outbreak caused by TPN contaminated with A. baumannii, R. radiobacter and P. diazotrophicus. The concomitant presence of clonal A. baumannii and P. diazotrophicus isolates in several TPN and blood samples, as well as the case of one patient, where all three different species were isolated simultaneously, suggest that the outbreak may be ascribed to a discrete contamination of TPN. In addition, this study highlights the clinical relevance of P. diazotrophicus, which has been involved in outbreaks in the past, but was often misidentified as P. agglomerans

Molecular investigation of isolates from a multistate polymicrobial outbreak associated with contaminated total parenteral nutrition in Brazil

Background: Between November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of Total Parenteral Nutrition (TPN) and/or calcium gluconate (CG) were reported in four Brazilian states. Methods: We analyzed 73 bacterial isolates from four states: 45 from blood, 25 from TPN and three from CG, originally identified as Acinetobacter baumannii, Rhizobium radiobacter, Pantoea sp. or Enterobacteriaceae using molecular methods. Results: The first two bacterial species were confirmed while the third group of species could not be identified using standard identification protocols. These isolates were subsequently identified by Multi-Locus Sequence Analysis as Phytobacter diazotrophicus, a species related to strains from similar outbreaks in the United States in the 1970’s. Within each species, TPN and blood isolates proved to be clonal, whereas the R. radiobacter isolates retrieved from CG were found to be unrelated. Conclusion: This is the first report of a three-species outbreak caused by TPN contaminated with A. baumannii, R. radiobacter and P. diazotrophicus. The concomitant presence of clonal A. baumannii and P. diazotrophicus isolates in several TPN and blood samples, as well as the case of one patient, where all three different species were isolated simultaneously, suggest that the outbreak may be ascribed to a discrete contamination of TPN. In addition, this study highlights the clinical relevance of P. diazotrophicus, which has been involved in outbreaks in the past, but was often misidentified as P. agglomerans