This review article examines the concept of viable but non-culturable (VBNC) bacteria, challenging both the terminology and underlying assumptions in the field. The author argues that bacteria such as Vibrio cholerae, Campylobacter jejuni, and Helicobacter pylori can enter states where they appear metabolically active by rapid viability assays but fail to grow in conventional culture media. However, the author contends that the term VBNC is logically flawed because culturability ultimately remains the only practical definition of viability. The article discusses two main categories of observations supporting VBNC: rapid viability assays showing intact cells that cannot be cultured, and disease patterns inconsistent with culture-based detection. The author proposes that cells classified as VBNC may instead represent injured bacteria capable of recovery under appropriate conditions, or that the human body may serve as a superior recovery medium compared to laboratory media. The article emphasizes the need for clearer terminology and integration between bacterial physiology and medical microbiology, recommending replacement of 'viable but non-culturable' with 'not immediately culturable' to avoid operational ambiguity. The author also addresses confusion surrounding the term 'dormancy' in clinical versus physiological contexts.

Key findings

• The term 'viable but non-culturable' is logically unsustainable operationally; cells that can be cultured under future conditions should be termed 'not immediately culturable' instead.
• VBNC phenomena may represent injured cells rather than a distinct physiological state comparable to sporulation, with recovery possible under appropriate laboratory or in vivo conditions.
• Metabolic activity and culturability are independent bacterial properties; metabolically active cells may be either culturable or non-culturable.
• The human intestine may function as a superior recovery medium compared to standard laboratory media, as demonstrated by Vibrio cholerae resuscitation.
• Clearer unified terminology rooted in physiological definitions is essential to bridge fundamental bacterial physiology with practical medical microbiology concerns.