Selection of resistance at lethal and non-lethal antibiotic concentrations.

Much of what we currently know about the genetics and evolution of antibiotic-resistance is based on selections with lethal drug concentrations that allow the detection of rare mutants with strong phenotypes. These data may be misleading with regard to the evolution of antibiotic resistance in natural environments, because bacteria are frequently exposed to concentration gradients of antibiotics. A significant part of antibiotic-resistance evolution may occur when bacteria are exposed to non-lethal concentrations of drug. High-resolution competition assays show that resistance mutations are rapidly enriched, and selected de novo, at very low antibiotic concentrations. Genomic analysis is providing a better understanding of how frequent and small-effect mutations selected at very low antibiotic concentrations contribute to the step-wise development of antibiotic resistance.