Much of in silico pathogen studies involve culture of the clinical isolates, NGS sequencing  followed by SNP calling . The novel polymorphisms are associated with drug resistance.

But, the genomic impact of the shift from host milieu to culture medium hardly gets attention. Would not the the change in growth conditions be causing acquisition of SNPs, indels and the chromosomal aberrations in the pathogen?

If drug stressor causes resistance development in the pathogens, the host immune pressure determines adaptation of pathogens too. In culture medium, the immune pressure and other competing microbes are lacking. Also the nutrient composition is much much different than host bio-fluid.

I will be surprised if not, for most of us are aware how mere optimization of growth medium substantially improves industrially-important microbial metabolite production. 

Discussions and expert opinions are appreciated.

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