The resistome of P. aeruginosa for three -lactam antibiotics, namely, ceftazidime, imipenem, and meropenem, was deciphered by screening a comprehensive PA14 mutant library for mutants with increased or reduced susceptibility to these antimicrobials. Confirmation of the phenotypes of all selected mutants was performed by Etest. Of the total of 78 confirmed mutants, 41 demonstrated a reduced susceptibility phenotype and 37 a supersusceptibility (i.e., altered intrinsic resistance) phenotype, with 6 mutants demonstrating a mixed phenotype, depending on the antibiotic. Only three mutants demonstrated reduced (PA0908) or increased (glnK and ftsK) susceptibility to all three antibiotics. Overall, the mutant profiles of susceptibility suggested distinct mechanisms of action and resistance for the three antibiotics despite their similar structures. More detailed analysis indicated important roles for novel and known -lactamase regulatory genes, for genes with likely involvement in barrier function, and for a range of regulators of alginate biosynthesis.Pseudomonas aeruginosa is an important opportunistic pathogen and a leading cause of nosocomial infections (32,41) and is the major cause of morbidity and mortality among individuals affected by cystic fibrosis (CF) (33). Infections caused by this opportunistic pathogen are difficult to eradicate due to its high intrinsic resistance to different classes of antibiotics. Treatment of patients is further complicated by the emergence of multidrug resistance arising principally from mutations, but also through acquisition of plasmids with antibiotic resistance determinants (32, 41).-Lactam antibiotics are among the main antibiotics currently used in anti-pseudomonal therapy (18,56). The killing mechanism of -lactams is initiated by binding to cell wall transpeptidases (penicillin-binding proteins [PBPs]), thus blocking an important step in peptidoglycan biosynthesis (59). This family of antibiotics includes penicillins, cephalosporins, monobactams, and carbapenems. Resistance to -lactams commonly results from drug inactivation by -lactamases, drug extrusion through efflux pumps, changes in outer membrane permeability, and modification of PBPs (46). However, recent publications have demonstrated that a myriad of genetic determinants modulate susceptibility to antibiotics, aside from those responsible for typical antibiotic resistance mechanisms, like the ones described above (8,16,19,52), especially when one considers mutations causing modest changes in the MIC (e.g., 2-fold). Furthermore, -lactam antibiotics are known to affect global gene expression, suggesting that the response to these drugs entails many different genes (1, 6).To identify novel genetic determinants involved in susceptibility to -lactams, we screened a comprehensive P. aeruginosa mutant library (31) for changes in the MICs of imipenem and meropenem (carbapenems) and ceftazidime (a cephalosporin). Our findings demonstrated that mutations in a broad array of genes belonging to different functional fami...