Arch Intern Med
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Most adults with community-acquired pneumonia are treated as outpatients. Despite this, the majority of studies regarding community-acquired pneumonia have been in hospitalized patients only and may not be applicable to an ambulatory population. This review critically examines the literature regarding the diagnosis, cause, appropriate patient selection, and treatment of nonhospitalized adults with community-acquired pneumonia, including human immunodeficiency virus-infected individuals. ⋯ Viral, mycoplasmal, and chlamydial agents are among the most common pathogens encountered in individuals treated as outpatients, although much variability exists. Many oral antibiotic trials for community-acquired pneumonia have been published, but shortcomings in study design limit their clinical applicability. A treatment algorithm is offered, using the best available data.
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Due to the hormonal and hemodynamic alterations inherent in the surgical experience, acute renal failure is common during the perioperative period. Acute renal failure occurs in 5% of hospital admissions, and the surgical setting is the second most common cause of inpatient acute renal failure. Because this setting has the highest mortality for acute renal failure, recognition of high-risk patients is essential for careful monitoring and prophylactic measures. ⋯ Patients with severe chronic renal failure or end-stage renal disease are at significant risk for development of complications during the perioperative period, due both to renal and nonrenal reasons. Hyperkalemia, infections, arrhythmias, and bleeding commonly occur in these patients during the perioperative period. This population has a reasonable surgical mortality for both general and cardiac surgery, but the extremely high morbidity warrants careful perioperative monitoring and care.