Bacterial cells have a subpopulation—persister cells—that have a low metabolism. Persister cells survive antimicrobial treatment and can regrow to cause chronic and recurrent infections.

Bacterial persister cells − a metabolically dormant subpopulation tolerant to antimicrobials − contribute to chronic infections and are thought to evade host immunity. In this work, we studied the ability of Pseudomonas aeruginosa persister cells to withstand host innate immunity. We found that persister cells resist MAC−mediated killing by the complement system despite being bound by complement protein C3b at levels similar to regular vegetative cells, in part due to reduced bound C5b - and are engulfed at a lower rate (10−100 fold), even following opsonization. Once engulfed, persister cells resist killing and, contrary to regular vegetative cells which induce a M1 favored (CD80+/CD86+/CD206−, high levels of CXCL-8, IL-6, and TNFα) macrophage polarization, they initially induce a M2 favored macrophage polarization (CD80+/CD86+/CD206+, high levels of IL−10, and intermediate levels of CXCL−8, IL−6, and TNF[&alpha]), which is skewed towards M1 favored polarization (high levels of CXCL−8 and IL−6, lower levels of IL−10) by 24 hours of infection, once persister cells awaken. Overall, our findings further establish the ability of persister cells to evade the innate host response and to contribute chronic infections.