In vitro persistence level reflects in vivo antibiotic survival of natural Pseudomonas aeruginosa isolates in a murine lung infection model

Nowadays, clinicians are more and more confronted with the limitations of antibiotics to completely cure bacterial infections in patients. It has long been assumed that only antibiotic resistance plays a pivotal role in this. Indeed, the worldwide emergence of antibiotic resistance is considered as one of the major health threats of the 21st century. However, the presence of persister cells also has a significant influence on treatment outcomes. These antibiotic-tolerant cells are present in every bacterial population and are the result of the phenotypic switching of normal, antibiotic-sensitive cells. Persister cells complicate current antibiotic therapies and contribute to the development of resistance. In the past, extensive research has been performed to investigate persistence in laboratory settings, however, antibiotic tolerance in conditions that mimic the clinical setting is still poorly understood. In this study, we have optimized a mouse model for lung infections of the opportunistic pathogen Pseudomonas aeruginosa . In this model, mice are intratracheally infected with P. aeruginosa embedded in seaweed alginate beads and subsequently treated with tobramycin via nasal droplets. A strain panel of 18 P. aeruginosa isolates originating from environmental, human and animal clinical sources was selected to assess survival in the animal model. These survival levels were positively correlated with the survival levels determined via time-kill assays which is a common method to study persistence in the laboratory. We showed that both survival levels are comparable and thus that the classical persister assays are indicative for antibiotic tolerance in a clinical setting. The optimized animal model also allows us to test potential antipersister molecules and study persistence. Importance The importance of targeting persister cells in antibiotic therapies becomes more evident as these antibiotic-tolerant cells underlie relapsing infections and resistance development. Here, we studied persistence in a clinically relevant pathogen, Pseudomonas aeruginosa . It is one of the six ESKAPE pathogens ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P. aeruginosa, Enterobacter spp.) that are considered as a major health threat. P. aeruginosa is mostly known for causing chronic lung infections in cystic fibrosis patients. We mimicked these lung infections in a mouse model to study persistence in more clinical conditions. We showed that the survival levels of natural P. aeruginosa isolates in this model are positively correlated with the survival levels measured in classical persistence assays. These results not only validate the use of our current techniques to study persistence, but also open opportunities to study new persistence mechanisms or evaluate new antipersister compounds in vivo . ### Competing Interest Statement The authors have declared no competing interest.