{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T11:06:59Z","timestamp":1772449619931,"version":"3.50.1"},"reference-count":23,"publisher":"Belitung Raya Foundation","issue":"2","license":[{"start":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T00:00:00Z","timestamp":1706400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: In resource-limited settings, addressing infections remains a substantial challenge in the management of children with Acute Myeloid Leukemia (AML). In Indonesia, infection-related mortality (IRM) is thought to be high compared to high-income countries. However, there has been no previous study of infection profile and IRM in Indonesian patients with AML.\nObjective: This study aimed to describe infections and IRM in children with AML treated according to the Indonesian National AML protocol and to describe the implementation of infection control practices in resource-limited settings.\nMethods: This retrospective observational study used secondary data from the medical records of pediatric patients with AML treated with the National Protocol at Dr. Sardjito Hospital, Yogyakarta, Indonesia, from April 2012 to September 2018. Essential patient characteristics, time of IRM, and cause of death were recorded, and infection control practices were observed. Data were analyzed using descriptive statistics.\nResults: 113 patients with AML were treated with the National protocol, and 83 met the inclusion criteria. Infections occurred in 69 (83%) patients with a total of 123 episodes (mean 1.8\/patient). Death was seen in 48 (58%) patients, with 19 (23%) IRM. The majority of infections were in the gastrointestinal tract (n = 51, 30.5%), sepsis (n = 29, 17%), and respiratory tract (n = 28, 17%). Infections mostly occurred during the first induction (41%). There were 90 (73%) episodes of clinically documented infection and 33 (27%) episodes of microbiologically documented infection. The positivity rate of blood cultures was only 27%. The majority of bacteria detected were gram-negative (n = 25, 69%), and among them were Klebsiella pneumonia (19%) and Escherichia coli (19%). Candida albicans was detected in 1 (2%) culture. Suboptimal infection prevention and control were found in the clinical practice.\nConclusion: Infections and infection-related mortality in children with AML treated using the National protocol were frequent, mainly occurring during the first induction phase. Compliance with infection prevention and control measures needs improvement. Urgent attention is required for better supportive care, including isolation rooms, antibiotics, and antifungals. The predominance of Gram-negative bacterial infections highlights the necessity for further research into effective prophylaxis. Enhanced healthcare and nursing professional vigilance and tailored antibiotic strategies are vital. Improving compliance and ensuring adequate supportive care resources are essential, emphasizing nursing\u2019s pivotal role. Further research is crucial to drive advancements in infection control strategies. <\/jats:p>","DOI":"10.33546\/bnj.3139","type":"journal-article","created":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T01:59:27Z","timestamp":1714269567000},"page":"185-191","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Infection-related mortality and infection control practices in childhood acute myeloid leukemia in a limited resource setting: Experience with the Indonesian national protocol"],"prefix":"10.33546","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3887-2117","authenticated-orcid":false,"given":"Eddy","family":"Supriyadi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignatius","family":"Purwanto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8904-1922","authenticated-orcid":false,"given":"Zeni","family":"Widiastuti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9345-561X","authenticated-orcid":false,"given":"Inggar","family":"Armytasari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6683-9358","authenticated-orcid":false,"given":"Salsabila","family":"Sandi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-2137","authenticated-orcid":false,"given":"Bambang","family":"Ardianto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-8475","authenticated-orcid":false,"given":"Gertjan J. L.","family":"Kaspers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"19163","published-online":{"date-parts":[[2024,4,28]]},"reference":[{"key":"90160","doi-asserted-by":"crossref","unstructured":"Ali, A. M., Weisel, D., Gao, F., Uy, G. L., Cashen, A. F., Jacoby, M. A., Wartman, L. D., Ghobadi, A., Pusic, I., & Romee, R. (2017). Patterns of infectious complications in acute myeloid leukemia and myelodysplastic syndromes patients treated with 10\u2010day decitabine regimen. Cancer Medicine, 6(12), 2814-2821. https:\/\/doi.org\/10.1002\/cam4.1231","DOI":"10.1002\/cam4.1231"},{"key":"90161","doi-asserted-by":"crossref","unstructured":"Ariza Heredia, E. J., & Chemaly, R. F. (2018). Update on infection control practices in cancer hospitals. CA: A Cancer Journal for Clinicians, 68(5), 340-355. https:\/\/doi.org\/10.3322\/caac.21462","DOI":"10.3322\/caac.21462"},{"key":"90162","doi-asserted-by":"crossref","unstructured":"Bochennek, K., Hassler, A., Perner, C., Gilfert, J., Sch\u00f6ning, S., Klingebiel, T., Reinhardt, D., Creutzig, U., & Lehrnbecher, T. (2016). Infectious complications in children with acute myeloid leukemia: Decreased mortality in multicenter trial AML-BFM 2004. Blood Cancer Journal, 6(1), e382-e382. https:\/\/doi.org\/10.1038\/bcj.2015.110","DOI":"10.1038\/bcj.2015.110"},{"key":"90163","unstructured":"Central Statistical Agency. (2017). Projected Population Number According to Province and Gender (Thousand People), 2015-2017 [in Bahasa]. https:\/\/www.bps.go.id\/id\/statistics-table\/2\/MTg4NiMy\/jumlah-penduduk-hasil-proyeksi-menurut-provinsi-dan-jenis-kelamin--ribu-jiwa-.html"},{"key":"90164","doi-asserted-by":"crossref","unstructured":"Chong, Y., Shimoda, S., Miyake, N., Aoki, T., Ito, Y., Kamimura, T., & Shimono, N. (2017). Incomplete recovery of the fecal flora of hematological patients with neutropenia and repeated fluoroquinolone prophylaxis. Infection and Drug Resistance, 193-199. https:\/\/doi.org\/10.2147\/IDR.S133333","DOI":"10.2147\/IDR.S133333"},{"key":"90165","doi-asserted-by":"crossref","unstructured":"Creutzig, U., Zimmermann, M., Reinhardt, D., & Lehrnbecher, T. (2003). Analysis of causes of death during intensive chemotherapy according to treatment protocol AML-BFM 93. Klinische P\u00e4diatrie, 215(3), 151-158. https:\/\/doi.org\/10.1055\/s-2003-39374","DOI":"10.1055\/s-2003-39374"},{"key":"90166","doi-asserted-by":"crossref","unstructured":"Davis, K., & Wilson, S. (2020). Febrile neutropenia in paediatric oncology. Paediatrics and Child Health, 30(3), 93-97. https:\/\/doi.org\/10.1016\/j.paed.2019.12.002","DOI":"10.1016\/j.paed.2019.12.002"},{"key":"90167","doi-asserted-by":"crossref","unstructured":"Dutta, A., & Flores, R. (2019). Infection prevention in pediatric oncology and hematopoietic stem cell transplant recipients. In J. C. McNeil, J. R. Campbell, & J. D. Crews (Eds.), Healthcare-Associated Infections in Children: A Guide to Prevention and Management (pp. 281-299). Springer International Publishing. https:\/\/doi.org\/10.1007\/978-3-319-98122-2_16","DOI":"10.1007\/978-3-319-98122-2_16"},{"key":"90168","unstructured":"Dykewicz, C. A., Jaffe, H. W., & Kaplan, J. E. (2000). Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients; recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. https:\/\/stacks.cdc.gov\/view\/cdc\/13465"},{"key":"90169","doi-asserted-by":"crossref","unstructured":"Faizan, M., Caniza, M. A., Anwar, S., Kashif, R.-u.-A., Saleem, R., Javed, H., Zafar, A., Taj, M. M., Hameed, A., & Homsi, M. (2020). Infection prevention and control measures at the Children Hospital Lahore: A my child matters collaborative project. JCO Global Oncology, 6, 1540-1545. https:\/\/doi.org\/10.1200\/GO.20.00403","DOI":"10.1200\/GO.20.00403"},{"key":"90170","unstructured":"Indonesia Ministry of Health. (2017). Minister of Health Regulation No. 27 concerning guidelines for infection prevention and control in health service facilities [in Bahasa]. Jakarta: Indonesia Ministry of Health Retrieved from http:\/\/hukor.kemkes.go.id\/uploads\/produk_hukum\/PMK_No._27_ttg_Pedoman_Pencegahan_dan_Pengendalian_Infeksi_di_FASYANKES_.pdf"},{"key":"90171","doi-asserted-by":"crossref","unstructured":"Kalaskar, P., Anand, A., Panchal, H., Patel, A., Parikh, S., & Shah, S. (2017). A comparative study of bloodstream infections in acute myeloid leukemia according to different phases of treatment: Can we predict the organism? South Asian Journal of Cancer, 6(03), 132-133. https:\/\/doi.org\/10.4103\/2278-330X.214584","DOI":"10.4103\/2278-330X.214584"},{"key":"90172","doi-asserted-by":"crossref","unstructured":"Kilpatrick, M., Hutchinson, A., Manias, E., & Bouchoucha, S. L. (2021). Paediatric nurses\u2019, children's and parents\u2019 adherence to infection prevention and control and knowledge of antimicrobial stewardship: A systematic review. American Journal of Infection Control, 49(5), 622-639. https:\/\/doi.org\/10.1016\/j.ajic.2020.11.025","DOI":"10.1016\/j.ajic.2020.11.025"},{"key":"90173","doi-asserted-by":"crossref","unstructured":"Klein, K., van Litsenburg, R. R. L., de Haas, V., Dors, N., van den Heuvel\u2010Eibrink, M. M., Knops, R. R. G., Tissing, W. J. E., Versluys, B. A., Zwaan, C. M., & Kaspers, G. J. L. (2020). Causes of early death and treatment\u2010related death in newly diagnosed pediatric acute myeloid leukemia: recent experiences of the Dutch Childhood Oncology Group. Pediatric Blood & Cancer, 67(4), e28099. https:\/\/doi.org\/10.1002\/pbc.28099","DOI":"10.1002\/pbc.28099"},{"key":"90174","doi-asserted-by":"crossref","unstructured":"Molgaard Hansen, L., M\u00f6tt\u00f6nen, M., Glosli, H., J\u00f3nmundsson, G. K., Abrahamsson, J., Hasle, H., Nordic Society of Paediatric, H., & Oncology. (2010). Early and treatment\u2010related deaths in childhood acute myeloid leukaemia in the Nordic countries: 1984\u20132003. British Journal of Haematology, 151(5), 447-459. https:\/\/doi.org\/10.1111\/j.1365-2141.2010.08389.x","DOI":"10.1111\/j.1365-2141.2010.08389.x"},{"key":"90175","unstructured":"Parikh, S., Goswami, P., Anand, A., Panchal, H., Patel, A., Kulkarni, R., & Shastri, B. (2018). Clinical and microbiological profile of infections during induction phase of acute myeloid leukemia. The Gulf Journal of Oncology, 1(27), 18-23."},{"key":"90176","doi-asserted-by":"crossref","unstructured":"Ruhnke, M., Arnold, R., & Gastmeier, P. (2014). Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. The Lancet Oncology, 15(13), e606-e619. https:\/\/doi.org\/10.1016\/S1470-2045(14)70344-4","DOI":"10.1016\/S1470-2045(14)70344-4"},{"key":"90177","doi-asserted-by":"crossref","unstructured":"Stoll, P., da Rocha Silla, L. M., Cola, C. M. M., Splitt, B. I., & Moreira, L. B. (2013). Effectiveness of a Protective Environment implementation for cancer patients with chemotherapy-induced neutropenia on fever and mortality incidence. American Journal of Infection Control, 41(4), 357-359. https:\/\/doi.org\/10.1016\/j.ajic.2012.05.018","DOI":"10.1016\/j.ajic.2012.05.018"},{"key":"90178","doi-asserted-by":"crossref","unstructured":"Sung, L., Lange, B. J., Gerbing, R. B., Alonzo, T. A., & Feusner, J. (2007). Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia. Blood, The Journal of the American Society of Hematology, 110(10), 3532-3539. https:\/\/doi.org\/10.1182\/blood-2007-05-091942","DOI":"10.1182\/blood-2007-05-091942"},{"key":"90179","unstructured":"Supriyadi, E., Purwanto, I., & Widjajanto, P. H. (2015). Implementation of adapted AML treatment in limited resources country (Indonesia National AML Protocol): Interim results. Pediatric Blood & Cancer, 62(S1), 55. https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/pbc.25505"},{"key":"90180","doi-asserted-by":"crossref","unstructured":"Taj, M., Farzana, T., Shah, T., Maqsood, S., Ahmed, S. S., & Shamsi, T. S. (2015). Clinical and microbiological profile of pathogens in febrile neutropenia in hematological malignancies: A single center prospective analysis. Journal of Oncology, 2015, 596504. https:\/\/doi.org\/10.1155\/2015\/596504","DOI":"10.1155\/2015\/596504"},{"key":"90181","doi-asserted-by":"crossref","unstructured":"Tomblyn, M., Chiller, T., Einsele, H., Gress, R., Sepkowitz, K., Storek, J., Wingard, J. R., Young, J. A., & Boeckh, M. J. (2009). Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: A global perspective. Bone Marrow Transplantation, 44(8), 453-455. https:\/\/doi.org\/10.1038\/bmt.2009.254","DOI":"10.1038\/bmt.2009.254"},{"key":"90182","doi-asserted-by":"crossref","unstructured":"Zengin, E., Sarper, N., Gelen, S. A., Demirsoy, U., Karado\u011fan, M., K\u0131l\u0131\u00e7, S. \u00c7., \u00d6ncel, S., Ar\u0131soy, E. S., & D\u00fcndar, D. (2017). High infection-related mortality in pediatric acute myeloid leukemia without preventive antibiotics and antifungals: Retrospective cohort study of a single center from a middle-income country. Turkish Journal of Hematology, 34(4), 340-344. https:\/\/doi.org\/10.4274\/tjh.2017.0052","DOI":"10.4274\/tjh.2017.0052"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3139\/925","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3139\/967","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3139\/925","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T02:06:09Z","timestamp":1714269969000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/3139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,28]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,4,28]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.3139","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,28]]},"assertion":[{"value":"2023-11-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-25","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}