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. 2023 Feb 14;13:2639. doi: 10.1038/s41598-023-29590-0

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Effect of efflux pumps expression and cephalosporinase activity on susceptibility to carbapenems (imipenem and meropenem) and to DDAC. For the representative short panel strains (n = 13) and 2 reference strains (PAO1 and PA14), MIC variation of the strains to (a) imipenem, (b) meropenem, and (c) DDAC in the absence or presence of PAβN, an efflux pump inhibitor, or cloxacillin, a cephalosporinase inhibitor. A distinction was made between strains with DS to DDAC (DDAC-R strains), carbapenem resistance (Carba-R strains), both phenotypes (Double-R strains), or neither phenotype (Double-S strains). The symbols represent individual MIC values, and the bars represent the average MIC for each strain type. By default, MIC values < 1 were replaced with 0.5. (d) Fold-change of expression of mexA, mexB, oprM, mexE, mexF, and oprN genes compared to PAO1 for three strains expressing VIM-2 carbapenemase.