Persister formation and antibiotic tolerance of chronic infections

Abstract

Two different types of mechanisms allow bacteria to evade killing by antibiotics—genetically encoded resistance and phenotypic tolerance conferred by persister cells. While our knowledge of resistance mechanisms is fairly sophisticated, understanding of tolerance is still fragmentary, partly because the phenomenon is only displayed by a few rare cells. Treatment of acute infections has benefited substantially from our understanding of mechanisms of resistance. It is reasonable to expect that treatment of chronic infections will similarly benefit from deciphering the mechanisms that cause the formation of drug-tolerant persisters. In this chapter, we will discuss both the mechanism of persister formation and therapeutic approaches to eradicate these seemingly invincible cells.