***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infa rct ion in 6 to 12 hours . The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin , creatine kinase (CK)-MB , and troponin I could exclude acute myocardial infa rct ion in ≤3 hours . Methods and Results —We prospect ively enrolled consecutive patients ( n=817 ) in the emergency department who were evaluated for possible acute myocardial infa rct ion . In patients with nondiagnostic ECGs , we measured CK-MB , troponin I , and myoglobin with a point-of-care device at presentation and at 90 minutes , 3 hours , and 9 hours . St and ard central laboratory testing of CK-MB was done at the same time intervals , and triage decisions were made by emergency physicians who were unaware of point-of-care results . Sensitivity and negative predictive value were compared for both the multimarker , point-of-care approach and the central laboratory strategy . Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9 % and 99.6 % , respectively . CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value . Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device ( P < 0.001 ) . Conclusions —Acute myocardial infa rct ion can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation ABSTRACT The diagnosis of severe pneumococcal infections is inadequate , relying heavily on culture of Streptococcus pneumoniae from blood or other normally sterile fluids , and is severely limited by prior administration of antibiotics . We evaluated prospect ively the Binax NOW S. pneumoniae urinary antigen test , a rapid immunochromatographic assay , for the diagnosis of bacteremic pneumococcal infections in hospitalized adult patients . Antigen was detected in 88 of 107 cases overall , result ing in a test sensitivity of 82 % ( 95 % confidence interval [ 95 % CI ] , 74 to 89 % ) . Antigen detection was greater in those with pneumonia ( 67 of 77 [ 87 % ] ) than in those without pneumonia ( 21 of 30 [ 70 % ] ) ( P = 0.04 ) . Urinary antigen was also detected in 3 of 106 adult patients with community-acquired septicemic infections caused by other organisms , giving a test specificity of 97 % ( 95 % CI , 92 to 99 % ) . For 45 pneumococcal bacteremia patients with a positive test on treatment day 1 , urinary antigen excretion was monitored for the first week of antibiotic treatment . Antigen was still detectable in 83 % ( 29 of 35 tested ; 95 % CI , 66 to 93 % ) on treatment day 3 . Detection of urinary antigen is a valuable , sensitive , and rapid test for the early diagnosis of bacteremic pneumococcal infections in adult patients , even after antibiotic treatment has commenced BACKGROUND : The rapidly evolving p and emic of novel 2009 swine-origin influenza A ( H1N1 ) virus ( S-OIV ) dem and s that accurate and practical diagnostics be urgently evaluated for their potential clinical utility . OBJECTIVE : To determine the diagnostic accuracy of a rapid influenza diagnostic test ( RIDT ) and direct fluorescent antibody ( DFA ) assay for S-OIV by using reverse-transcription polymerase chain reaction ( RT-PCR ) as the reference st and ard . METHODS : We prospect ively recruited children ( aged 0–17 years ) assessed in the emergency department of a pediatric referral hospital and a community pediatric clinic for influenza-like illness between May 22 and July 25 , 2009 .  RIDT ( performed on-site ) and DFA were compared with RT-PCR to determine their sensitivity and specificity for S-OIV . We also compared the sensitivity of RIDT for S-OIV to that for seasonal influenza over 2 preceding seasons . RESULTS : Of 820 children enrolled , 651 were from the emergency department and 169 were from the clinic .  RIDT sensitivity was 62 % ( 95 % confidence interval [ CI ] : 52%–70 % ) for S-OIV , with a specificity of 99 % ( 95 % CI : 92%–100 % ) . DFA sensitivity was 83 % ( 95 % CI : 75%–89 % ) and was superior to that of RIDT ( P < .001 ) . RIDT sensitivity for S-OIV was comparable to that for seasonal influenza when using DFA supplemented with culture as the reference st and ard . RIDT sensitivity for influenza viruses was significantly higher in children 5 years of age or younger ( P = .003 ) and in patients presenting ≤2 days after symptom onset ( P < .001 ) . CONCLUSIONS : The sensitivity of RIDT  for detection of S-OIV is higher than recently reported in mixed adult-pediatric population s but remains suboptimal INTRODUCTION The cost-effectiveness of blood cultures in community-acquired pneumonia ( CAP ) has been question ed . Although penicillin-resistant Streptococcus pneumoniae is an increasing problem , penicillin therapy , where appropriate , reduces cost and may reduce antibiotic resistance . Blood cultures , however , can only reduce cost if physicians are prepared to alter therapy based on the results . We review ed our experience to determine how often physicians changed management based on blood culture results positive for S pneumoniae . METHODS Retrospective chart review was performed of all CAP admissions between January 1996 and December 1998 with blood culture results positive for S pneumoniae . RESULTS Seventy-four patients out of 1,805 patients admitted with CAP during this period had pneumococcemia .  Penicillin resistance was identified in 15 cases ( 20.3 % ; high grade in 4 cases ) with cephalosporin resistance in 4 of these cases ( 1 high grade ) . Fifty-one patients had initial empiric therapy with a third-generation cephalosporin , and 58 patients had empiric coverage of atypical organisms ; no patient received empiric penicillin therapy . Blood culture results altered management in 31 patients ( 41.9 % ) , but in only 2 cases was this due to antibiotic resistance . Fifty-one patients without penicillin allergy grew penicillin-sensitive pneumococci ; only 11 patients ( 21.6 % ) were changed to penicillin therapy . Thirteen of 35 patients ( 37.1 % ) who were given an additional antibiotic for atypical coverage had this antibiotic ceased . CONCLUSION Despite evidence of penicillin-sensitive pneumococcal CAP , physicians were reluctant to narrow antibiotic therapy , potentially adding to treatment cost and reducing the impact of blood culture results on management . The impact of penicillin resistance was reduced by the usual empiric choice of a third-generation cephalosporin . While positive blood culture results can clearly be useful in the management of patients with CAP , their cost-effectiveness needs to be assessed in prospect i ve clinical trials Background With the current influenza A H1N1 p and emic ( H1N1pdm ) , it is extremely important that clinicians can quickly and accurately identify influenza cases . Methodology /Principal Findings To investigate the performance of the QuickVue Influenza A+B rapid test , we conducted a prospect i ve study of the diagnostic accuracy of the QuickVue Influenza A+B test compared to real-time reverse transcriptase-polymerase chain reaction ( RT-PCR ) for influenza A H1N1pdm in Nicaraguan children aged 2 to 14 years . Rapid test sensitivity and specificity compared to real-time RT-PCR were 64.1 % ( 95 % CI 53.5 , 73.9 ) and 98.3 % ( 95.0 , 99.6 ) , respectively . Agreement between the two tests was 86.4 % ( 95 % CI 81.7 , 90.3 ) , and kappa was calculated to be 0.67 ( 95 % CI 0.56 , 0.76 ) . Performance of the rapid test varied by day of presentation , with a sensitivity of 41.7 % ( 95 % CI 22.1 , 63.4 ) for sample s from children presenting on the day of symptom onset and a sensitivity of 72.1 % ( 95 % CI 59.9 , 82.3 ) for sample s from children presenting one or more days post-symptom onset . Conclusions / Significance We found that the rapid test performed with moderate sensitivity and high specificity . Test performance varied by day of onset , with lower sensitivity on the day of symptom onset BACKGROUND Little is known about the impact of community-acquired respiratory coinfection in patients with p and emic 2009 influenza A(H1N1 ) virus infection . METHODS This was a prospect i ve , observational , multicenter study conducted in 148 Spanish ICUs . RESULTS Severe respiratory syndrome was present in 645 ICU patients . Coinfection occurred in 113 ( 17.5 % ) of patients . Streptococcus pneumoniae ( in 62 patients [ 54.8 % ] ) was identified as the most prevalent bacteria . Patients with coinfection at ICU admission were older ( 47.5±15.7 vs 43.8±14.2 years , P<.05 ) and presented a higher APACHE ( Acute Physiology and Chronic Health Evaluation ) II score ( 16.1±7.3 vs 13.3±7.1 , P<.05 ) and Sequential Organ Failure Assessment ( SOFA ) score ( 7.0±3.8 vs 5.2±3.5 , P<.05 ) . No differences in comorbidities were observed . Patients who had coinfection required vasopressors ( 63.7 % vs 39.3 % , P<.05 ) and invasive mechanical ventilation ( 69 % vs 58.5 % , P<.05 ) more frequently . ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not ( 11 [ interquartile range , 5 - 23 ] vs 8 [ interquartile range 4 - 17 ] , P=.01 ) . Coinfection was associated with increased ICU mortality ( 26.2 % vs 15.5 % ; OR , 1.94 ; 95 % CI , 1.21 - 3.09 ) , but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality . CONCLUSIONS During the 2009 p and emics , the role played by bacterial coinfection in bringing patients to the ICU was not clear , S pneumoniae being the most common pathogen . This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health re sources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of cases BACKGROUND The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia ( CAP ) is not well defined . We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP . METHODS A prospect i ve study of all adults hospitalized with CAP was performed from February 2007 through January 2008 . To evaluate the accuracy of the test , we calculated its sensitivity , specificity , positive and negative predictive values , and positive and negative likelihood ratios . The gold st and ard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid ( definite diagnosis ) and isolation in sputum ( probable diagnosis ) . Antibiotic modifications , complications , and mortality were analyzed . RESULTS A total of 474 episodes of CAP were included . Streptococcus pneumoniae was the causative pathogen in 171 cases ( 36.1 % ) . It was detected exclusively by urinary antigen test in 75 cases ( 43.8 % ) . Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae . Specificity was 96 % , positive predictive value ranged from 88.8 % to 96.5 % , and the positive likelihood ratio ranged from 14.6 to 19.9 . The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients . Pneumonia was cured in all of them . Potentially , this optimization would be possible in the 75 patients diagnosed exclusively by the test . CONCLUSION When its findings are positive , the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes Background : Mucosal coinfections with respiratory viruses and Streptococcus pneumoniae are common , but the role of rhinovirus infections in the development of invasive pneumococcal disease ( IPD ) in children has not been studied . Methods : During 1995 and 2007 , we analyz 
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RESULTS There was no evidence of association between diagnostic group and prescribing or clinical outcomes .
All tests had limitations .
We found no evidence that POCTs for influenza or S. pneumoniae , or PCR for influenza or RSV influenced antimicrobial prescribing or clinical outcomes .
The total costs and QALYs of each diagnostic strategy were similar , although , incrementally , PCR was the most cost-effective strategy .
The analysis does not support routine use of POCTs for either influenza or pneumococcal antigen for adults presenting with acute cardiopulmonary conditions , but suggests that conventional viral culture for clinical diagnosis should be replaced by PCR .