High Cell Density and Antimicrobial Persistence in Streptococcus Pyogenes
Abstract Streptococcus pyogenes (group A Streptococcus-GAS) is an important pathogen for humans. GAS has been associated with severe and invasive diseases. Despite the fact that these bacteria remain universally susceptible to penicillin, therapeutic failures have been reported in some GAS infections. Many hypotheses have been proposed to explain these antibiotic-unresponsive infections, however none of them has fully elucidated this phenomenon. In this study, antimicrobial persistence emerged when GAS strains were grown at high cell density. Strong efflux activity was detected, and gene expression assays by real-time qRT-PCR showed upregulation of some genes associated with efflux pumps in persistent cells arising in the presence of penicillin. Subsequent phenotypic reversion and whole-genome sequencing indicated that this event was due to non-inherited resistance mechanisms. The tiny persistent colonies showed downregulation of genes associated with protein biosynthesis and cell growth, as demonstrated by gene expression assays. Moreover, proteomic analyses showed that susceptible cells express higher levels of ribosome proteins. The generation of persistent cells due to high bacterial load might be an important mechanism of clinical resistance in GAS invasive infections that has been overlooked. The phenomenon described here might shed some light on the origin of therapeutic failures in S. pyogenes infections.