Failure of combination therapy for Staphylococcus aureus bone infection: a case of in vivo selection with resistance to rifampicin and fusidic acid

Abstract

Staphylococcus aureus is one of the main etiologies of bone and device-related infections. Treatment of these orthopedic infections combines mostly rifampicin with other antibiotics. The recurrence or failure rate after fusidic acid/rifampicin treatment remains low (<10%). We discuss here a case of antibiotic treatment failure for Staphylococcus aureus bone infection with in vivo selection of rifampicin and fusidic acid resistance. We also report a new mutation in fusA gene involved in fusidic acid resistance.

Keywords:

• Biofilm
• bone
• fusA
• resistance
• rpoB
• Staphylococcus aureus

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this report.

Funding information

This project was funded by an internal grant at Nantes University Hospital.