ArticleCommunications biology2021
The highly dynamic nature of bacterial heteroresistance impairs its clinical detection.
Article in Communications biology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 1 of them a synthesis that pooled it.
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Who cites it
53 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.
- Global trends and research profile of antibiotic heteroresistance: a bibliometric and visual analysis.Frontiers in microbiology · 2026Pooled it
- Within-patient carbapenem heteroresistance inCurrent research in microbial sciences · 2026Article
- Bacterial strategies for surviving antibiotics during urinary tract infection: could uropathogenic Escherichia coli be persisters?Nature reviews. Urology · 2026Review
- Population size modulates the transition from gene amplification-mediated heteroresistance to stable resistance.npj antimicrobials and resistance · 2026Article
- Selective context, rather than persister cycling alone, drives resistance fixation in Escherichia coli.npj antimicrobials and resistance · 2026Article
- Cobalt and nickel ion synergy promotes gene amplification and stable metal resistance inApplied and environmental microbiology · 2026Article
- From resistance mechanisms to therapy: Antimicrobial resistance in Gram-negative bacteria.Journal of microbiology (Seoul, Korea) · 2026Review
- Bacterial heteroresistance mechanisms, dynamics, and emerging diagnostic approaches.Bioscience reports · 2026Review
- Droplet microfluidics with image texture quantification for detection of rare antibiotic-resistant subpopulations from bloodstream infections.NPJ digital medicine · 2026Article
- Heteroresistance to amikacin inMicrobiology spectrum · 2026Article
- High-resolution, high-throughput detection of hidden antibiotic resistance with the dilution-and-delay (DnD) susceptibility assay.Nature communications · 2026Article
- Global in silico genomic epidemiology of tetracycline resistance in Staphylococcus aureus: one health dynamics and genotype-phenotype associations.Molecular genetics and genomics : MGG · 2026Article
- The dynamic distribution of genetic tandem amplifications in a heteroresistant Escherichia coli population revealed by ultra-deep long read sequencing.Nature communications · 2026Article
- A nutrient bottleneck controls antibiotic efficacy in structured bacterial populations.Nature communications · 2026Article
- An Investigation of Colistin Heteroresistance inBioMed research international · 2026Article
- Microfluidics to Meet Antibiotic Resistance: A Growing Research Frontier.Antibiotics (Basel, Switzerland) · 2025Review
- Article
- The Rapid CarbaLux Combination Test to Uncover Bacterial Resistance and Heteroresistance Prior to Antibiotic Treatment.Diagnostics (Basel, Switzerland) · 2025Article
- Article
- Implications of gene expression heterogeneity in the interplay between acquired resistance and bacterial metabolism.Scientific reports · 2025Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Many bacterial species and antibiotic classes exhibit heteroresistance, a phenomenon in which a susceptible bacterial isolate harbors a resistant subpopulation that can grow in the presence of an antibiotic and cause treatment failure. The resistant phenotype is often unstable and without antibiotic selection it reverts back to susceptibility. Here we studied the dynamics by which these resistant subpopulations are enriched in the presence of antibiotic and recede back to their baseline frequency in the absence of selection. An increasing understanding of this instability will allow more effective diagnostics and treatment of infections caused by heteroresistant bacteria. We show for clinical isolates of Escherichia coli and Salmonella enterica that different antibiotics at levels below the MIC of the susceptible main population can cause rapid enrichment of resistant subpopulations with increased copy number of genes that cause resistance. Modelling and growth rate measurements of bacteria with increased gene copy number in cultures and by microscopy of single-cells in a microfluidic chip show that the fitness cost of gene amplifications and their intrinsic instability drives their rapid loss in the absence of selection. Using a common antibiotic susceptibility test, we demonstrate that this test strongly underestimates the occurrence of heteroresistance in clinical isolates.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.