Two ceftazidime-resistant variants of Pseudomonas aeruginosa (PA-48, PA-60), obtained from cardiac vegetations of rabbits with endocarditis receiving ceftazidime therapy, were studied for mechanisms of resistance. Both resistant variants were stably derepressed for the type Id I-lactamase, which was ceftazidime inducible in the parental strain (PA-96) used to initially infect the rabbits. There was no evidence of ceftazidime bioinactivation by the resistant strains, and their outer membrane permeabilities were comparable to those of the parental strain. No alterations were observed in patterns of outer membrane proteins or membrane lipopolysaccharides in the resistant variants as compared with the parental strain. Penicillin-binding protein patterns of the resistant variants revealed the absence of penicillin-binding protein 4 in both, with acquisition of a new protein of higher apparent molecular weight in PA-60. Calculation of the rate of appearance of ceftazidime in the periplasm at sub-MICs suggested that slow enzymatic hydrolysis of the P-lactam, rather than nonhydrolytic trapping, was the major explanation for the induced resistance in vivo in strains PA-48 and PA-60.,-Lactam antibiotics are of primary use in the therapy of gram-negative bacterial infections. However, the appearance of bacterial resistance to successive generations of P-lactams (30,36) has necessitated the continuous development and assessment of new compounds. The major impediments to ,-lactam therapy have been the high intrinsic resistance of some organisms, including Pseudomonas aeruginosa due to the intrinsic barrier properties of their outer membranes (21, 39) and the acquisition of high levels of P-lactamase due either to the presence of a plasmid or to the derepression of a formerly inducible, chromosomally encoded , B-lactamase (30, 34, 36). Mutational alterations in the 3-lactam targets, penicillin-binding proteins (PBPs), have also been observed (26) but seem to occur with somewhat less frequency. One novel approach taken by pharmaceutical companies in the development of newer ,-lactam antibiotics has been to search for compounds that are refractory to ,-lactamase-mediated hydrolysis. Recently, however, it has been observed that, despite the extremely low rates at which these compounds are hydrolyzed, clinical isolates of P. aeruginosa and Enterobacter cloacae that are resistant to these so-called P-lactamase-stable P-lactams often have much-increased levels of the chromosomal P-lactamase (4,30,31,(34)(35)(36). The mechanism of resistance has been suggested to involve nonhydrolytic binding of the ,-lactam by molecules of ,-lactamase, thus reducing the periplasmic concentration (i.e., the concentration in the vicinity of the target PBPs) to subinhibitory levels (34). Alternatively, Vu and Nikaido (35) have argued convincingly that a combination of low-level hydrolysis by ,-lactamase (low Km. low Vmax) and reduced outer membrane permeability, thus di-* Corresponding author. t Present address: