Risk factors for vancomycin-resistant enterococcus bacteremia and its influence on survival after allogeneic hematopoietic cell transplantation.

Vancomycin-resistant enterococcus (VRE) is a well-known infectious complication among immunocompromised patients. We performed a retrospective analysis to identify risk factors for the development of VRE bacteremia (VRE-B) within 15 months after allogeneic hematopoietic cell transplantation (alloHCT) and to determine its prognostic importance for other post-transplant outcomes. Eight hundred consecutive adult patients who underwent alloHCT for hematologic diseases from 1997 to 2011 were included. Seventy-six (10%) developed VRE-B at a median of 46 days post transplant. Year of transplant, higher HCT comorbidity score, a diagnosis of ALL, unrelated donor and umbilical cord blood donor were all significant risk factors on multivariable analysis for the development of VRE-B. Sixty-seven (88%) died within a median of 1.1 months after VRE-B, but only four (6%) of these deaths were attributable to VRE. VRE-B was significantly associated with worse OS (hazard ratio 4.28, 95% confidence interval 3.23-5.66, P<0.001) in multivariable analysis. We conclude that the incidence of VRE-B after alloHCT has increased over time and is highly associated with mortality, although not usually attributable to VRE infection. Rather than being the cause, this may be a marker for a complicated post-transplant course. Strategies to further enhance immune reconstitution post transplant and strict adherence to infection prevention measures are warranted.

Addressing social factors of adolescent reproductive health in the Republic of Georgia.

The influence of social factors on reproductive health has been highlighted by researchers in the last decade, yet programmes to improve adolescent reproductive health (ARH) rarely address social factors such as gender discrimination. Beginning in 2004, CARE International implemented and evaluated a three-year ARH project to address individual behaviour change, institutional capacity and local social norms related to ARH in a rural district of the Republic of Georgia. Community engagement strategies included: promoting community support for ARH by adolescent/adult volunteer change agents; building health providers' capacity to better meet the needs of adolescents; and using 'Theatre for Development' to promote community dialogue about social norms. Project evaluation data demonstrated improved knowledge, attitudes, behaviour about family planning, improved institutional capacity to provide adolescent services and some evidence of shifts in gender norms. Community engagement is critical for successful strategies to influence social norms that promote healthy reproductive health.