The prevailing paradigm of infectious disease is based on the work of Koch and colleagues, who more than 150 years ago isolated individual strains of bacteria and developed the pure culture method that is still used today. That work enlightened medicine by firmly establishing the germ theory of transmissible diseases and demonstrated that diseases like dysentery, tuberculosis, and anthrax are caused by microbiological agents.1 Hence, the field of microbiology developed around Koch's methods with clinical microbiologists working overwhelmingly with pure log-phase cultures in nutrient-rich media because this approach provided such a powerful tool for the study of acute epidemic bacterial diseases. However, this approach that examines only planktonic bacteria (free-floating, single cell phenotype) may have limited development of a more thorough understanding of microbial processes. In most natural environments and in chronic bacterial infections, the planktonic phenotype generally exists only transiently, and usually as a minor population.
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