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Antibiotic persistence comprises drug-tolerant bacteria that can survive treatment with antibacterial agents, despite lacking classical genetic resistance mechanisms. Therefore, persisters are clinically relevant because they can lead to treatment failures and chronic infections. Additionally, antibiotic persistence facilitates the evolution of resistance through genetic mutations. Persisters are triggered by a lack of nutrients, bacterial toxins, low ATP levels, or other stress responses that shut down bacterial metabolism. However, the involvement of prophages, viruses that integrate into bacterial chromosomes, is less well understood. In this study, we tested a tisAB deletion in Salmonella Typhimurium and examined persister cell formation following treatment with the DNA-damaging drug ciprofloxacin. TisB is a bacterial toxin that increases the influx of protons across the inner bacterial membrane into the cytosol, causing ATP depletion. We demonstrate that the deletion of tisAB increases prophage induction and bacterial killing, leading to a reduced persister cell fraction. The tisAB mutant is unable to down regulate its ATP concentration after exposure to ciprofloxacin, which in turn allows for stronger binding of RecA to single-stranded DNA, the activator of both the SOS response and prophage induction.
Heteroresistance (HR) in bacteria describes a subpopulational phenomenon of antibiotic resistant cells of a generally susceptible population. Here, we investigated the molecular mechanisms and phenotypic characteristics underlying HR to ceftazidime (CAZ) in a clinical Enterobacter cloacae complex strain (ECC). We identified a plasmid-borne gene duplication-amplification (GDA) event of a region harbouring an ampC gene encoding a β-lactamase bla DHA-1 as the key determinant of HR. Individual colonies exhibited variations in the copy number of the genes resulting in resistance level variation which correlated with growth onset (lag times) and growth rates in the presence of CAZ. GDA copy number heterogeneity occurred within single resistant colonies, demonstrating heterogeneity of GDA on the single-cell level. The interdependence between GDA, lag time and antibiotic treatment and the strong plasticity underlying HR underlines the high risk for misdetection of antimicrobial HR and subsequent treatment failure.
