Community-acquired methicillin-resistant Staphylococcus aureus in bone and joint infections : development of rifampicin resistance

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is usually susceptible to a wider range of antibiotics than nosocomial or multiresistant MRSA, but evidence is lacking to guide antibiotic choices. Rifampicin plus fusidic acid is commonly used in multiresistant MRSA infection, and familiarity makes this combination attractive for CA-MRSA. We report two cases of CA-MRSA infection in which rifampicin resistance developed during treatment. Non-compliance may have been a significant factor, but high bacterial load and persistent foci of infection were also likely contributors. We caution against using regimens containing rifampicin in such cases.