An Overlooked Cause of Rifampin Resistance

INTRODUCTION Staphylococcus and Streptococcus sp. are the most common pathogens causing a wide range of complications following joint replacement procedures.1 These microorganisms grow in biofilms attached to the prosthetic implants, which allows them to evade the host’s immune response and resist antibiotics.2 As a result, the rate of joint failure has been increasing steadily, which prompted research into the most optimal approach for treating prosthetic joint infections. Treatment usually consists of surgery and antibiotics capable of penetrating bone and biofilm producing pathogens. In this report, we focus on antibiotic therapy in prosthetic joint infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). We present a case of relapsing MRSA bacteremia associated with development of rifampin resistance in a patient with L3-L4 discitis, ischial and lumbar osteomyelitis, and psoas abscess.