Temporal Shifts in Antibiotic Resistance Elements Govern Virus-Pathogen Conflicts

Bacteriophage predation selects for diverse anti-phage systems that frequently cluster on mobilizable defense islands in bacterial genomes. However, there remains a lack of molecular insight into the reciprocal dynamics of phage-bacterial adaptations in nature, particularly in clinical contexts where there is need to inform phage therapy efforts and understand how phages drive pathogen evolution. Here, using time-shift experiments we show that fluctuations in SXT integrative and conjugative elements (ICEs), which notoriously confer antibiotic resistance, govern Vibrio choleraes susceptibility to phages in clinical samples. We find that SXT ICEs, which are widespread in Gammaproteobacteria, invariably encode phage defense and function to protect other genera from phage attack following conjugation. We discover phage counter-adaptation to SXT-mediated restriction in clinical samples, and show that heterogeneity in SXT ICEs allows for re-emergence of phage resistance. Further, phage infection stimulates high frequency SXT ICE conjugation, leading to the concurrent dissemination of phage and antibiotic resistance.