Antibiotic persistence and tolerance: not just one and the same

S Ronneau, PWS Hill, S Helaine - Current Opinion in Microbiology, 2021 - Elsevier
Current Opinion in Microbiology, 2021Elsevier
Distinguished by their penetrance within a population, antibiotic tolerance and persistence
are superficially similar phenomena by which growth-restricted bacteria survive treatment
with bactericidal antibiotics. Owing to their apparent similarity, it is often assumed that the
same physiological states and molecular mechanisms underlie the ability of individual
antibiotic tolerant and persistent bacteria to survive treatment. Experimentally, antibiotic
persistence is an extremely challenging phenomenon to study due to both its transience and …
Distinguished by their penetrance within a population, antibiotic tolerance and persistence are superficially similar phenomena by which growth-restricted bacteria survive treatment with bactericidal antibiotics. Owing to their apparent similarity, it is often assumed that the same physiological states and molecular mechanisms underlie the ability of individual antibiotic tolerant and persistent bacteria to survive treatment. Experimentally, antibiotic persistence is an extremely challenging phenomenon to study due to both its transience and the co-existence of persisters with non-persisters in the population of interest. In contrast, antibiotic tolerance operates at the whole population level as a result of bacteria acquiring genetic mutations or encountering environmental conditions that result in growth restriction. Therefore, studying antibiotic tolerance is often used as a convenient way to understand the molecular mechanisms governing antibiotic persistence. In this opinion, we discuss our current understanding of these two phenomena, outlining how tolerance and persistence can be distinguished experimentally. We argue that this approach will help avoid controversies in the field, especially in instances where the two phenomena co-exist. Finally, we evaluate the clinical evidence implicating tolerance and persistence in recalcitrance and relapse of bacterial infections.
Elsevier
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