Overview of heteroresistance, persistence and optimized strategies to control them

Antibiotic-resistant bacteria have become much more prevalent, posing a significant concern to universal care. In basic concepts, the phenomenon of heteroresistance is typified as antibiotic resistance displayed by a subgroup of the entire bacterial community which is typically thought to be sensitive to these antibiotics based on standard in-vitro sensitivity assays. Although this small subgroup is temporarily dormant nondividing state displays enhanced resistance to broad antibiotics ranges. Persistence is a subpopulation of a sensitive bacterial isolate that can tolerate the bactericidal antibiotics because of its dormant physiological state. Until recent times, the occurrence of heteroresistance and persistence phenomena are often misunderstood and perhaps neglected. Here, we review the outline literature about bacterial heteroresistance, their detection methods, their associated mechanisms, the objectives of some bacterial species to develop heteroresistance. Bacterial persistence, some of their features, their main mechanisms, and their clinical importance are also described. Furthermore, this study provides optimized strategies to combat both phenomena.