Antibiotic Persistence Unveiled: Mechanisms of Dormancy and Resilience
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Bacterial persisters represent a unique subset of bacteria that endure antibiotic exposure and pose a significant challenge to clinical treatment. Despite extensive studies and reviews on antibiotic persistence, understanding its underlying mechanisms remains elusive. A common misconception conflates persistence with mechanisms, such as resistance, heteroresistance, tolerance, and immune evasion, which can result in diagnostic and therapeutic complications. Distinguishing these processes is important for improving the management of persistent infections and designing effective treatments. This review summarizes bacterial persistence mechanisms, focusing on phenotypic heterogeneity, stress responses, and adaptive processes. The phenomenon is different from resistance and tolerance because of genetic stability and population dynamics. Furthermore, the ability of persisters to revert to a susceptible phenotype following the cessation of antibiotic exposure highlights the importance of targeted therapeutic approaches. Common persisters, including ESKAPE pathogens, emphasize the clinical and economic burden posed by antibiotic persistence. This review aims to provide insight into persistence to inspire novel strategies for combating antibiotic-resistant infections and improving therapeutic outcomes.
Abstract
Bacterial persisters represent a unique subset of bacteria that endure antibiotic exposure and pose a significant challenge to clinical treatment. Despite extensive studies and reviews on antibiotic persistence, understanding its underlying mechanisms remains elusive. A common misconception conflates persistence with mechanisms, such as resistance, heteroresistance, tolerance, and immune evasion, which can result in diagnostic and therapeutic complications. Distinguishing these processes is important for improving the management of persistent infections and designing effective treatments. This review summarizes bacterial persistence mechanisms, focusing on phenotypic heterogeneity, stress responses, and adaptive processes. The phenomenon is different from resistance and tolerance because of genetic stability and population dynamics. Furthermore, the ability of persisters to revert to a susceptible phenotype following the cessation of antibiotic exposure highlights the importance of targeted therapeutic approaches. Common persisters, including ESKAPE pathogens, emphasize the clinical and economic burden posed by antibiotic persistence. This review aims to provide insight into persistence to inspire novel strategies for combating antibiotic-resistant infections and improving therapeutic outcomes.