Disruption of the PA2491 gene in a mini-Tn5-tet insertion mutant of a clinical isolate of Pseudomonas aeruginosa increased expression of the mexEF-oprN multidrug efflux genes and decreased production of outer membrane protein OprD, concomitant with enhanced resistance to chloramphenicol, quinolones, and imipenem, which was reminiscent of previously described nfxC mutants. PA2491 encodes a probable oxidoreductase previously shown to be positively regulated by the MexT positive regulator of mexEF-oprN expression (T. Köhler, S. F. Epp, L. K. Curty, and J. C. Pechére, J. Bacteriol. 181:6300-6305, 1999). Spontaneous multidrugresistant mutants of the P. aeruginosa clinical isolate hyperexpressing mexEF-oprN and showing reduced production of OprD were readily selected in vitro, and all of them were shown to carry mutations in PA2491, highlighting the probable significance of such mutations as determinants of MexEF-OprN-mediated multidrug resistance in vivo.Three-component multidrug efflux systems of the resistancenodulation-division (RND) family are prevalent in gram-negative bacteria, in which they contribute significantly to intrinsic and acquired resistance to a range of clinically important antimicrobial agents (i.e., antibiotics and biocides) (48). In Pseudomonas aeruginosa, an opportunistic human pathogen characterized by an innate resistance to multiple antimicrobial agents (19), seven tripartite RND family efflux systems have been described to date 35,50,51 [25,52,54,64,73] and mexZ [40,69], respectively).The MexEF-OprN system is apparently quiescent in wildtype cells, at least under the usual laboratory growth conditions (32), but it is expressed in nfxC-type multidrug-resistant strains isolated in vitro (14, 32, 42) and in clinics (15,24). nfxC mutants display resistance to fluoroquinolones, chloramphenicol, trimethoprim, and the carbapenem imipenem (14, 32), although resistance to imipenem results not from MexEF-OprN expression (32) but from the concomitant decrease in outer membrane protein OprD in these mutants (14,42). OprD is a basic amino acid-peptide channel and a primary route of entry for carbapenems, such as imipenem, in P. aeruginosa (67, 68), and it is often absent in imipenem-resistant strains of P. aeruginosa (4, 31). In addition to its role in the export of and resistance to antimicrobials, MexEF-OprN also promotes resistance (or tolerance) to organic solvents (36), dyes (16), and biocides, such as triclosan (8). As a result of MexEF-OprN hyperexpression, nfxC mutants also express reduced levels of several quorum-sensing (i.e., homoserine lactone)-dependent extracellular virulence factors (33) and are attenuated for virulence (10), apparently as a result of MexEF-OprN-mediated export of a molecule(s) necessary for homoserine lactone production (33).Unlike the majority of RND-type efflux systems in P. aeruginosa, which are negatively regulated by linked repressor genes, MexEF-OprN expression is positively regulated by the product of the linked mexT gene, a LysR family regulator of mexEFoprN expr...