“…(i) MexAB-OprM. Constitutively ex-pressed, the MexAB-OprM pump was the first RND system characterized in P. aeruginosa (10,13,388), although a link between the development of MDR and increased amounts of an OM protein, OprM, had previously been established in in vitro-selected mutants (389) and was also analyzed together with other overproduced 50-kDa OM proteins (11 MexAB-OprM-overproducing mutants can be readily generated by in vitro selection in the presence of an antibiotic(s) (11,389,402), and in vitro studies on reference strains have shown that any mutational event inactivating the mexR (also called nalB), nalC, or nalD gene or impairing the activity of their respective products (MexR, ArmR, and NalD [see Regulation of Multidrug Efflux Pumps, below]) results in the overexpression (Ն3-fold) of mexAB-oprM with a concomitant increase in resistance (2-to 16-fold MIC increases) to all the pump substrates compared to baseline levels, with nalC mutants being in general 2-fold more susceptible than the nalB and nalD mutants (393,(403)(404)(405)(406)(407)(408)(409). Similar findings were reported for phenotypically but non-genetically characterized multidrug-resistant mutants selected in vitro with various antibiotics (11,12,392,402,410,411).…”