Orthopedic
foreign body-associated
infections are often treated with
rifampin-based combination antimicrobial
therapy. We previously observed that
rifampin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) isolates were present 2 days after cessation of
rifampin therapy in experimental
foreign body osteomyelitis. Unexpectedly, only
rifampin-susceptible isolates were detected 14 days after the completion of treatment. We studied two
rifampin-resistant isolates recovered 2 days
after treatment and one
rifampin-susceptible isolate recovered 14 days
after treatment. Growing these isolates alone in vitro or in vivo demonstrated no fitness defects; however, in mixed culture,
rifampin-susceptible bacteria outcompeted
rifampin-resistant bacteria. In vivo, two courses of
rifampin treatment (25 mg/kg of
body weight every 12 h for 21 days) yielded a greater decrease in bacterial quantity in the bones of treated animals 14 days following treatment than that in animals receiving a single course of treatment (P = 0.0398). In
infections established with equal numbers of
rifampin-resistant and
rifampin-susceptible bacteria, one course of
rifampin treatment did not affect bacterial quantities.
Rifampin-resistant and
rifampin-susceptible isolates were recovered both 2 days and 14 days following treatment completion; however, the proportion of animals with
rifampin-resistant isolates was lower at 14 days than that at 2 days following treatment completion (P = 0.024). In untreated animals infected with equal numbers of
rifampin-resistant and
rifampin-susceptible bacteria for 4 weeks,
rifampin-susceptible isolates were exclusively recovered, indicating the outcompetition of
rifampin-resistant by
rifampin-susceptible isolates. The data presented imply that although there is no apparent fitness defect in
rifampin-resistant bacteria when grown alone, they are outcompeted by
rifampin-susceptible bacteria when the two are present together. The findings also suggest that selected
rifampin resistance may not persist in initially
rifampin-susceptible
infections following the discontinuation of
rifampin.