Using selection by non-antibiotic stressors to sensitize bacteria to antibiotics

Bacterial resistance to one antibiotic is frequently accompanied by cross-resistance to other drugs. Similarly, non-antibiotic selective forces, from biocides to osmotic stress, have been shown to decrease antibiotic susceptibility, often the result of shared, non-specific resistance mechanisms. On the other hand, evolved resistance to particular antibiotics may also be associated with increased sensitivity to other drugs, high-lighting evolutionary constraints that could form the basis for novel anti-resistance strategies. While recent studies indicate this collateral sensitivity is common between antibiotics, much less is known about potentially sensitizing effects of non-antibiotic stressors. In this study, we use laboratory evolution to investigate adaptation of E. faecalis, an opportunistic bacterial pathogen, to a broad collection of environmental agents, ranging from antibiotics and biocides to extreme pH and osmotic stress. We find that non-antibiotic selection frequently leads to increased sensitivity to other conditions, including multiple antibiotics. Based on the measured resistance profiles, we hypothesized that sequential rounds of antibiotic and non-antibiotic selection may further enhance sensitivity by harnessing the orthogonal collateral effects of particular pairs of selective forces. To test this hypothesis, we show experimentally that populations evolved to a sequence of linezolid (an oxazolidinone antibiotic) and sodium benzoate (a common preservative) exhibit increased sensitivity to more stressors than adaptation to either condition alone. The results demonstrate how sequential adaptation to drug and non-drug environments can be used to sensitize bacterial to antibiotics and highlight new potential strategies for exploiting shared constraints governing adaptation to diverse environmental challenges.