ABSTRACT
Bacterial cells exhibit a kind of adaptation in response to the environment or stress, called persister cells. These cells are metabolically inactive and acquired multidrug resistance via mutation or horizontal gene transfer. Persister cells remains in a dormant state in the presence of antibiotics and regrow in the absence of the drug. During infection, persister cells become one of the major challenges in the treatment. These persisters are the main cause for the antibiotic tolerance in biofilm and biofilm associated infections. The mechanism behind the persister formation is not well understood, due to the limitations in isolating the persister cells. Studies reported that toxin-antitoxin, (p)ppGpp, SOS response, and ATP levels are some of the mechanisms known for the persistence of bacterial cells. A better understanding of the basic mechanisms behind the persister formation and its recalcitrance to antibiotic therapy may be good approach in the development of treatment strategies.
