The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.
Patients with Long-Term Oral Carriage Harbor High-Persister Mutants of Candida albicans
Open accessAbstract
Fungal biofilms produce a small number of persister cells which can tolerate high concentrations of fungicidal agents. Persisters form upon attachment to a surface, an important step in the pathogenesis of Candida strains. The periodic application of antimicrobial agents may select for strains with increased levels of persister cells. In order to test this possibility, 150 isolates of Candida albicans and C. glabrata were obtained from cancer patients who were at high risk for the development of oral candidiasis and who had been treated with topical chlorhexidine once a day. Persister levels were measured by exposing biofilms growing in the wells of microtiter plates to high concentrations of amphotericin B and plating for survivors. The persister levels of the isolates varied from 0.2 to 9%, and strains isolated from patients with long-term carriage had high levels of persisters. High-persister strains were isolated from every patient with Candida carriage of more than 8 consecutive weeks but from no patients with transient carriage. All of the high-persister isolates had an amphotericin B MIC that was the same as that for the wild type, indicating that these strains were drug-tolerant rather than drug-resistant mutants. Biofilms of the majority of high-persister strains also showed an increased tolerance to chlorhexidine and had the same MIC for this antimicrobial as the wild type. This study suggests that persister cells are clinically relevant, and antimicrobial therapy selects for high-persister strains in vivo. The drug tolerance of persisters may be a critical but overlooked component responsible for antimicrobial drug failure and relapsing infections.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“LaFleur and colleagues reported that isolates from cancer patients with long-term C. albicans oral colonization displayed significantly higher levels of persistence compared to those from short-term carriers [13].”
From Antifungal persistence: Clinical relevance and mechanisms (2025) · cites this paper as [13]
Citations
Cites
Persister cells, dormancy and infectious disease
Lewis, K. (2007) · Nature Reviews Microbiology · doi:10.1038/nrmicro1557 · Cited by 2,052
Self-citationIsogenic strain construction and gene mapping in Candida albicans.
Fonzi, W. A., & Irwin, M. Y. (1993) · Genetics · doi:10.1093/genetics/134.3.717 · Cited by 1,695
Candida biofilms and their role in infection
Douglas, L. J. (2003) · Trends in Microbiology · doi:10.1016/s0966-842x(02)00002-1 · Cited by 1,150
Spoering, A. L., & Lewis, K. (2001) · Journal of Bacteriology · doi:10.1128/jb.183.23.6746-6751.2001 · Cited by 907
Self-citationSpecialized Persister Cells and the Mechanism of Multidrug Tolerance in Escherichia coli
Keren, I., Shah, D., Spoering, A. L., Kaldalu, N., & Lewis, K. (2004) · Journal of Bacteriology · doi:10.1128/jb.186.24.8172-8180.2004 · Cited by 848
Self-citationStandardized Method for In Vitro Antifungal Susceptibility Testing of Candida albicans Biofilms
Ramage, G., Vande Walle, K., Wickes, B. L., & López-Ribot, J. L. (2001) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.45.9.2475-2479.2001 · Cited by 753
Moyed, H. S., & Bertrand, K. P. (1983) · Journal of Bacteriology · doi:10.1128/jb.155.2.768-775.1983 · Cited by 641
Odds, F. C., & Bernaerts, R. (1994) · Journal of Clinical Microbiology · doi:10.1128/jcm.32.8.1923-1929.1994 · Cited by 631
Persisters: a distinct physiological state of E. coli
Khodursky, A. B., Zhang, Z., Devang, S., Kaldalu, N., Kurg, K., & Lewis, K. (2006) · Digital Repository Service (Northeastern University) · doi:10.1186/1471-2180-6-53 · Cited by 630
Self-citationPersister cells and the riddle of biofilm survival
Lewis, K. (2005) · Biochemistry (Moscow) · doi:10.1007/s10541-005-0111-6 · Cited by 524
Self-citation
Research works printed but not linked: 1
- Ghannoum, M. A., and S. S. Radwan. 1990. The adherence process, p. 106-154. InCandida adherence to epithelial cells. CRC Press, Boca Raton, FL.
Cited by
Sorted by citations
Lewis, K. (2010) · Annual Review of Microbiology · doi:10.1146/annurev.micro.112408.134306 · Cited by 1,858
Self-citationPlatforms for antibiotic discovery
Lewis, K. (2013) · Nature Reviews Drug Discovery · doi:10.1038/nrd3975 · Cited by 1,527
Self-citationDefinitions and guidelines for research on antibiotic persistence
Balaban, N. Q., Helaine, S., Lewis, K., Ackermann, M., Aldridge, B., Andersson, D. I., Brynildsen, M. P., Bumann, D., Camilli, A., Collins, J. J., et al. (2019) · Nature Reviews Microbiology · doi:10.1038/s41579-019-0196-3 · Cited by 1,313
Self-citationPersistent bacterial infections and persister cells
Fisher, R. A., Gollan, B., & Helaine, S. (2017) · Nature Reviews Microbiology · doi:10.1038/nrmicro.2017.42 · Cited by 1,243
Beceiro, A., Tomás, M., & Bou, G. (2013) · Clinical Microbiology Reviews · doi:10.1128/cmr.00059-12 · Cited by 1,118
Metadata
- Authors
- LaFleur, M. D., Qi, Q., & Lewis, K.
- Affiliations
- Northeastern University (US)
- Antimicrobial Discovery Center and Department of Biology, Northeastern University, 360 Huntington Avenue, Boston, Massachusetts 02115
- Corresponding author
- Lewis, Kim
- ORCID
- Lewis, Kim
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2010-01
- Volume
- 54
- Issue
- 1
- Pages
- 39-44
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- PMC
- PMC2798516
- OpenAlex
- W2115712103
- Cited by
- 237
- References
- 32
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 14 · 2023: 9 · 2022: 16 · 2021: 21 · 2020: 18 · 2019: 16 · 2018: 9 · 2017: 15 · 2016: 21 · 2015: 24 · 2014: 12 · 2013: 24 · 2012: 17
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Antimicrobial Agents and Chemotherapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (30400498)
- National Institute of General Medical Sciences (R01GM061162)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bacterial biofilms and quorum sensing
- Keywords
- Candida albicans, Candida glabrata, persister cells, fungal biofilms, oral candidiasis, drug tolerance, antimicrobial selection, cancer patients, infection relapse
- MeSH terms
- Adult, Aged, Candida albicans, Candidiasis, Carrier State, Chlorhexidine, Dose-Response Relationship, Drug, Female, Genes, Fungal, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Mouth, Mouthwashes, Mutation, Neoplasms, Biofilms, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review