Ceftaroline and ceftobiprole monotherapy for the treatment of Staphylococcus aureus infections: a systematic review and Bayesian meta-analysis

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• Picked for Microbiology (medical) (top studies of the week, 19 July 2026).

Abstract

BACKGROUND: The comparative efficacy of ceftaroline and ceftobiprole against standard of care for Staphylococcus aureus infections, including methicillin-resistant S. aureus remains uncertain. Thus, we conducted a systematic review and Bayesian meta-analysis to assess the efficacy and safety of ceftaroline and ceftobiprole monotherapy for non-urinary S. aureus infections. METHODS: We registered the protocol in PROSPERO. We searched PubMed, Embase, Scopus, and Web of Science. We included randomized controlled trials and comparative non-randomized studies reporting adjusted estimates, enrolling patients with non-urinary S. aureus infections. The primary analysis assessed clinical cure in randomized trials using a Bayesian random-effects model with a vague prior. For ceftaroline, we additionally conducted an exploratory analysis using an observationally informed prior derived from non-randomized studies with variance inflation. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. RESULTS: Sixteen studies met inclusion criteria [11 ceftaroline (1030 subjects); 5 ceftobiprole (1265 subjects)]. In the primary analysis, the pooled odds ratio for clinical cure was 1.38 (95% CrI 0.81-2.44) for ceftaroline and 0.99 (95% CrI 0.59-1.62) for ceftobiprole. The exploratory ceftaroline analysis using an observationally informed prior yielded an odds ratio of 1.45 (95% CrI 0.91-2.38). Adverse events and serious adverse events were similar between groups. Certainty of evidence was low for ceftaroline and moderate for ceftobiprole. CONCLUSIONS: Current evidence does not demonstrate superiority of ceftaroline or ceftobiprole over standard-of-care therapy for clinical cure in non-urinary S. aureus infections. Estimates remain imprecise and are largely driven by registrational trials and subgroup data. These findings support cautious, indication-specific interpretation rather than routine preference of these agents over established therapies.

Abstract as published, via PubMed.