Silver-resistant mutants were selected by stepwise exposure of silver-susceptible clinical strains of Escherichia coli, two of which did not contain any plasmids, to either silver nitrate or silver sulfadiazine. These mutants showed complete cross-resistance to both compounds. They showed low-level cross-resistance to cephalosporins and HgCl 2 but not to other heavy metals. The Ag-resistant mutants had decreased outer membrane (OM) permeability to cephalosporins, and all five resistant mutants tested were deficient in major porins, either OmpF or OmpF plus OmpC. However, the well-studied OmpF-and/or OmpC-deficient mutants of laboratory strains K-12 and B/r were not resistant to either silver compound. Resistant strains accumulated up to fourfold less 110m AgNO 3 than the parental strains. The treatment of cells with carbonyl cyanide m-chlorophenylhydrazone increased Ag accumulation in Ag-susceptible and -resistant strains, suggesting that even the wild-type Ag-susceptible strains had an endogenous Ag efflux activity, which occurred at higher levels in Ag-resistant mutants. The addition of glucose as an energy source to starved cells activated the efflux of Ag. The results suggest that active efflux, presumably coded by a chromosomal gene(s), may play a major role in silver resistance, which is likely to be enhanced synergistically by decreases in OM permeability.Silver (Ag) is a biologically nonessential metal which is used widely in photographic emulsions. The toxicity of Ag has also led to clinical applications, including the topical treatment of bacterial infections with silver nitrate (AgNO 3 ) and silver sulfadiazine (AgSD). The action of AgNO 3 and AgSD is assumed to be dependent on the Ag ϩ ions, which strongly inhibit bacterial growth through poisoning of respiratory enzymes and electron transport components and through interference with DNA functions (3, 18).Ag-resistant bacterial strains have been isolated from both clinical and environmental sources. Examples include strains of Acinetobacter baumannii (4), Escherichia coli (7), Enterobacter cloacae (7), Klebsiella pneumoniae (7), Pseudomonas aeruginosa (19), Pseudomonas stutzeri (5), and Salmonella typhimurium (15). In some cases the resistance was shown to be encoded by plasmids (4,5,15,27,31).Mechanisms of resistance to other metals such as arsenic, cadmium, copper, and mercury have been elucidated at the molecular level (for reviews, see references 3, 27, and 28). Resistance is sometimes due to enzymatic detoxification as in the case of mercury and organomercurials (28). But in a majority of cases energy-dependent ion efflux seems to be responsible, as exemplified by bacterial resistance to many oxyanions (such as arsenite, antimonite, and chromate) as well as to the cations zinc, cobalt, cadmium, and nickel (3, 27, 28). Solioz and Odermatt (30) have shown recently that a P-type copper efflux ATPase from a gram-positive bacterium, Enterococcus hirae, can also pump out, perhaps fortuitously, Ag ϩ . Little is known, however, about the mechanism of Ag...