CTX-M -lactamases, which show a high cefotaxime hydrolytic activity, constitute the most prevalent extended-spectrum -lactamase (ESBL) type found among clinical isolates. The recent explosive diversification of CTX-M enzymes seems to have taken place due to the appearance of more efficient enzymes which are capable of hydrolyzing both cefotaxime and ceftazidime, especially among the CTX-M-1 cluster. A combined strategy of in vitro stepwise evolution experiments using bla CTX-M-1 , bla CTX-M-3 , and bla CTX-M-10 genes and site-directed mutagenesis has been used to evaluate the role of ceftazidime and other -lactam antibiotics in triggering the diversity found among enzymes belonging to this cluster. Two types of mutants, P167S and D240G, displaying high ceftazidime MICs but reduced resistance to cefotaxime and/or cefepime, respectively, were identified. Such an antagonistic pleiotropic effect was particularly evident with P167S/T mutations. The incompatibility between P167S and D240G changes was demonstrated, since double mutants reduced susceptibility to both ceftazidime and cefotaxime-cefepime; this may explain the absence of strains containing both mutations in the clinical environment. The role of A77V and N106S mutations, which are frequently associated with P167S/T and/or D240G, respectively, in natural strains, was investigated. The presence of A77V and N106S contributes to restore a high-level cefotaxime resistance phenotype, but only when associated with mutations P167S and D240G, respectively. However, A77V mutation increases resistance to both cefotaxime and ceftazidime when associated with CTX-M-10. This suggests that in this context this mutation might be considered a primary site involved in resistance to broad-spectrum cephalosporins.-Lactam agents constitute not only the most widely and frequently used group of antibacterial drugs but also the one that includes the largest variety of molecules. Continuous exposure to a diverse array of -lactams seems to have been driving the explosive diversification found among all -lactamase groups (18,29). A number of investigations have identified the amino acid positions among classic TEM, SHV, or OXA enzymes that evolved under these multiple and coincidental selective events. Such changes are responsible for increasing affinity and hydrolytic activity against the newest -lactams, leading to extended-spectrum -lactamases (ESBLs) (11,21,34).CTX-M enzymes probably originated in environmental organisms, where they confer a negligible level of resistance to cefotaxime (12, 27, 32). However, when present as acquired -lactamases in Enterobacteriaceae (known as cefotaximases) they confer a high cefotaxime-hydrolytic activity (4, 19). Since the original description in 1989 (4), a rapid and extensive radiation of different CTX-M clusters and variants has occurred, with more than 60 molecular forms described to date and classified into five clusters based on amino acid sequence homology (http://www.lahey.org /studies/webt.htm). Such accelerated variability mig...