The arn locus, found in many Gram-negative bacterial pathogens, mediates resistance to polymyxins and other cationic antimicrobial peptides through 4-amino-L-arabinose modification of the lipid A moiety of lipopolysaccharide. In Pseudomonas aeruginosa, several two-component regulatory systems (TCSs) control the arn locus, which is necessary but not sufficient for these resistance phenotypes. A previous transposon mutagenesis screen to identify additional polymyxin resistance genes that these systems regulate implicated an open reading frame designated PA1559 in the genome of the P. aeruginosa PAO1 strain. Resequencing of this chromosomal region and bioinformatics analysis for a variety of P. aeruginosa strains revealed that in the sequenced PAO1 strain, a guanine deletion at the end of PA1559 results in a frameshift and truncation of a full-length open reading frame that also encompasses PA1560 in non-PAO1 strains, such as P. aeruginosa PAK. Deletion analysis in the PAK strain showed that this full-length open reading frame, designated cprA, is necessary for polymyxin resistance conferred by activating mutations in the PhoPQ, PmrAB, and CprRS TCSs. The cprA gene was also required for PmrAB-mediated resistance to other cationic antimicrobial peptides in the PAK strain. Repair of the mutated cprA allele in the PAO1 strain restored polymyxin resistance conferred by an activating TCS mutation. The deletion of cprA did not affect the arn-mediated lipid A modification, indicating that the CprA protein is necessary for a different aspect of polymyxin resistance. This protein has a domain structure with a strong similarity to the extended short-chain dehydrogenase/reductase family that comprises isomerases, lyases, and oxidoreductases. These results suggest a new avenue through which to pursue targeted inhibition of polymyxin resistance. P olymyxins (Pm) are acylated cationic peptides active against Pseudomonas aeruginosa and other Gram-negative pathogens. As pharmaceuticals, Pm B sulfate (PMB) and colistimethate, the prodrug form of colistin (also known as Pm E), are increasingly used to treat multidrug-resistant strains of P. aeruginosa that cause serious infections in critically ill patients and in those with cystic fibrosis (CF) (1, 2). Multidrug-resistant strains emerge when firstline agents, such as antipseudomonal -lactams, aminoglycosides, and fluoroquinolones, are used repeatedly, imposing major selective pressure (3-5). Unfortunately, the prevalence of clinical isolates of P. aeruginosa and other Gram-negative pathogens resistant to PMB and colistin is increasing (6-13).Pm binds to lipopolysaccharide (LPS), the major constituent of the Gram-negative outer membrane, promoting its own uptake and diffusion through the periplasm to the inner membrane, where it disrupts cellular respiration and leads to cell lysis (14). The resistance of Gram-negative pathogens to Pm and other cationic antimicrobial peptides (CAPs) is associated with covalent modification of LPS, namely, the addition of 4-amino-L-arabinose (L-Ara4...