Bacteriophages utilize pseudolysogeny to target non-replicating bacteria and CRISPR-resistant phages eliminate recalcitrant implant infections

ABSTRACT A key driver of bacterial infection treatment failure and relapse is the persistence of non-replicating bacterial subpopulations that emerge under stressors like nutrient starvation and immune pressure. These dormant cells evade antibiotics, fuelling recurrence and resistance. Bacteriophage therapy is a promising alternative, but its efficacy against non-replicating bacteria is poorly understood. Improving our understanding of bacteria-phage interactions under non-replicating conditions could greatly enhance phage therapeutic outcomes in clinics. By utilising various bacterial ( Mycobacterium smegmatis , Mycobacterium tuberculosis , and Pseudomonas aeruginosa ) and phage species, this study quantitatively demonstrates that lytic phages can infect non-replicating bacteria (under nutrient starvation, acidic pH or antibiotic pressure), persisting in a state of pseudolysogeny and resuming lysis upon bacterial regrowth. We find that the pseudolysogeny window is phage- and host-dependent, with degradation of extrachromosomal phage DNA leading to loss of pseudolysogeny. We find that Pseudomonas CRISPR defence plays a crucial role in phage DNA degradation even under non-replicating conditions, underscoring the need for its consideration in phage therapy design. We also demonstrated the in vivo relevance of pseudolysogeny and CRISPR-resistant bacteriophages in eliminating implant-associated and antibiotic-persistent Pseudomonas infections in mice. These findings highlight the need to consider phage-host dynamics and bacterial defences when designing phage-based strategies to target non-replicating bacteria and persistent infections.