Antibiotic resistance is a growing crisis that threatens many aspects of modern healthcare.Dogma is that resistance often develops due to acquisition of a resistance gene or mutation and that when this occurs, all the cells in the bacterial population are Cabinet phenotypically resistant.In contrast, heteroresistance (HR) is a form of antibiotic resistance where only a subset of cells within a bacterial population are resistant to a given drug.These resistant cells can rapidly replicate in the presence of the antibiotic and cause treatment failures.If and how HR and resistance are related is unclear.
Using carbapenem-resistant Enterobacterales (CRE), we provide evidence that HR to beta-lactams develops over years of antibiotic usage and that it is gradually supplanted by resistance.This suggests the possibility that HR may often develop before resistance and Stairarm Rail frequently be a stage in its progression, potentially representing a major shift in our understanding of the evolution of antibiotic resistance.