Selective context, rather than persister cycling alone, drives resistance fixation in Escherichia coli.

Abstract

Whether persister cells contribute to the evolution of antibiotic resistance and, if so, under what selective conditions this occurs, remain unresolved. Here, we examined whether repeated persister cycling itself promotes resistance evolution and how persister-associated minor variants are retained, lost, or fixed under distinct selective contexts. We compared five Escherichia coli cellular states: mutation-induced cells (M), persister-Amp cycling cells (A), persister cycling cells without selection (R), stationary-phase cells (S), and NaCl-stored persisters (P), using state-resolved whole-genome sequencing and phenotypic assays. Persister cycling without selection, stationary-phase cells, and NaCl-stored persisters maintained baseline MICs and showed no detectable high-frequency variant fixation. In contrast, mutation-induced cells fixed efflux-regulatory mutations in marR, acrR, and acrB, increasing MIC to 32 μg/mL. Persister-Amp cycling cells showed an intermediate MIC increase to 16 μg/mL without detectable quality-filtered genetic fixation, distinguishing this state from mutation-induced resistance. The stfE/stfP prophage background further shaped adaptive routes under mutation-inducing conditions. Exploratory analysis revealed sub-threshold low-frequency variant signals during persister cycling, but lineage tracking showed that these variants were not stage-specifically fixed and were instead stochastically retained or lost. These findings support a model in which persister cycling can reveal low-frequency genetic heterogeneity, but fixed resistance evolution requires selection that promotes variant retention and clonal expansion. Thus, resistance fixation was governed primarily by selective context during regrowth rather than by the persister state itself.