Pseudomonas aeruginosa: persistence beyond antibiotic resistance.

The persistence of Pseudomonas aeruginosa in chronic infections extends beyond the issue of antibiotic resistance. A critical, yet unresolved question is why antibiotics fail to eradicate all infecting bacteria, despite P. aeruginosa often being phenotypically susceptible. This highlights the need for a comprehensive understanding of persistence mechanisms, which we consider to be directly rooted in host-pathogen interactions and which are frequently overlooked. We propose that both gene regulatory adaptation and adaptive genetic evolution play fundamental roles in the long-term persistence of P. aeruginosa. Elucidating these complex interactions has profound clinical implications, but their elucidation depends on access to advanced and innovative model systems that accurately replicate host-pathogen relationships.