Quantitative comparison of similarities and differences in medicinal materials used by Tibetan medicine and the three traditional medicines (6th-10th Century AD).

Treatment of methicillin-resistant (MRSA) bacteremia remains a major clinical challenge because of its high rates of morbidity and mortality (). Each additional day of persistent bloodstream infection (BSI) has been shown to increase mortality risk by 16–20%, and patients with MRSA BSI exhibit a threefold increased likelihood of prolonged infection compared to those with methicillin-susceptible isolates. Ninety-day mortality rates in MRSA BSI have been reported to be as high as 39% (, ). Furthermore, persistent BSI has been associated with increased risk of metastatic foci and worse overall clinical outcomes (, , ). The Infectious Diseases Society of America (IDSA) describes persistent MRSA BSI as failure to achieve blood culture clearance within 7 days of index culture despite appropriate antimicrobial treatment. IDSA guidelines recommend consideration of an alternative regimen after 7 days of persistent bacteremia. One suggested regimen includes high-dose daptomycin (10 mg/kg/day, if susceptible) in combination with a second agent such as a β-lactam (). Different from most other β-lactam agents, the fifth-generation cephalosporin ceftaroline has activity against MRSA through its affinity for the mecA-encoded penicillin-binding protein 2a and has demonstrated synergy when combined with vancomycin and daptomycin (, ). Currently, its use in MRSA bacteremia remains an off-label indication (, ). Several previous studies have demonstrated the potential benefit of ceftaroline-based combination therapy in MRSA BSI, with lower mortality rates reported compared with monotherapy (, ). Geriak et al. reported a 0% versus 26% in-hospital mortality rate in the daptomycin-plus-ceftaroline combination therapy and monotherapy groups, respectively, when combination therapy was initiated within 72 h of MRSA bacteremia, prompting early termination of the study due to ethical concerns (). The mortality benefit seen with receipt of dual therapy within 72 h of bacteremia onset suggests early transition to combination therapy may confer advantages beyond current guideline recommendations of escalating therapy at 7 days of persistent BSI (, ). This was further evidenced by separate research showing a correlation between time to transition from monotherapy to daptomycin-based dual therapy and the duration of bacteremia, although the average time of escalation to dual therapy was day 6 in this study (). Although outcomes have been variable with ceftaroline-vancomycin combination therapy, one study reported a microbiologic cure rate of nearly 97%, suggesting that it is another reasonable salvage regimen ().