Finding the Gold Standard When There isn’t One
In a health care environment rich in data but constrained by 24-hour days, Mayo Clinic researchers are working to make sense of it all. This includes finding out that some treatments don’t work.
In a recent study published by the journal CHEST, Mayo researchers examined the use of steroids to calm lung inflammation in patients with a certain type of pneumonia. The team found that for patient with Pneumocystis pneumonia unrelated to HIV, steroids didn’t seem to help.
“Knowing what works is half the battle, but knowing what doesn’t work is equally important,” says Erin Barreto, Pharm.D., R.Ph., a Mayo Clinic pharmacist and health services researcher. “We don’t want to give patients medications that are unlikely to help them, and actually could cause harm.”
Putting Evidence Behind Standard Practice
According to lead author Patrick Wieruszewski, Pharm.D., R.Ph., a second-year pharmacy resident in Critical Care in the Mayo Clinic School of Health Sciences, the type of lung inflammation experienced differs between patients with HIV and without.
“Pneumocystis pneumonia is a life threatening lung infection that can develop in any patient with a depleted immune system,” says Dr. Wieruszewski. “However, we knew that very little evidence existed for steroid use among non-HIV positive patients, and was sometimes contradictory.”
To gain more insight, the researchers looked back at the care of all patients with Pneumocystis pneumonia, without evidence of HIV, who were hospitalized at Mayo Clinic in Rochester, Minnesota, between 2006 and 2016. For these 323 patients, the researchers found that the use of steroids for Pneumocystis pneumonia did not result in any benefits in terms of lung function or survival.
“Providers should discuss the risks and benefits of using steroids with each patient, rather than just using them for all patients with Pneumocystis pneumonia and respiratory failure,” says Dr. Wieruszewski.
As pharmacists, Dr. Barreto and Dr. Wieruszewski play an important role in this discussion.
“Given the new information we now have, we will be able to help our care teams to better customize the treatment plan for each patient,” says Dr. Barreto. “We know that in some patients, steroids can cause problems with blood sugar, infection risk, mental status, and more; so individualizing treatment to each unique patient is critical.”
While the investigators say that this is not the end of the research process, they do agree that it was a piece of the puzzle that will help inform not only Mayo Clinic’s practice, but also the care of patients everywhere.
Sidenote: Dr. Barreto is the director of the second-year Critical Care Pharmacy residency program, and Dr. Wieruszewski’s mentor. Coincidentally, she also is a ‘student’ – the first pharmacist in the Kern Health Care Delivery Scholars Program – continuing the Mayo tradition of continuous learning and improvement.