{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:50:09Z","timestamp":1791474609700,"version":"4.3.4"},"reference-count":50,"publisher":"American Society for Microbiology","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P01-AI083214"],"award-info":[{"award-number":["P01-AI083214"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      persists in cystic fibrosis (CF) airways despite\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      antibiotic susceptibility, suggesting that efflux reprogramming driven by environmental and polymicrobial interactions with\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      promotes survival in this setting. In this study, we investigated how CF-like conditions and co-infection with\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      influence\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      physiology and antimicrobial response. Using artificial sputum medium (ASM) and co-culture models, we found that ASM induced a selective transcriptional response characterized by upregulation of the multidrug efflux pump\n                      <jats:italic toggle=\"yes\">tet38<\/jats:italic>\n                      , while other pumps remained minimally expressed. In the presence of\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      maintained\n                      <jats:italic toggle=\"yes\">tet38<\/jats:italic>\n                      expression but additionally induced\n                      <jats:italic toggle=\"yes\">norB<\/jats:italic>\n                      , indicating a redistribution of efflux activity under polymicrobial stress.\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      metabolites, including quinolines and phenazines, contributed to this response, and deletion of\n                      <jats:italic toggle=\"yes\">tet38<\/jats:italic>\n                      or\n                      <jats:italic toggle=\"yes\">norB<\/jats:italic>\n                      significantly reduced\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      fitness in ASM and co-culture conditions. Analysis of\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      clinical isolates from people with CF revealed a similar hierarchy, with Tet38 and NorB as the predominant efflux pumps, particularly in\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      isolates co-recovered with\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      . Despite exhibiting only low-level increases in MICs, these isolates demonstrated enhanced survival in ASM. Notably,\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      isolates paired with clinical\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      strains showed improved survival compared with survival when paired with a\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      reference strain, consistent with adaptation toward coexistence. Together, these findings demonstrate that CF-like environmental conditions and polymicrobial interactions drive selective reprogramming of efflux pumps that promote\n                      <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                      persistence without conferring high-level resistance, highlighting a mechanism of antibiotic tolerance not captured by standard susceptibility testing.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01070-26","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:52:42Z","timestamp":1791471162000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Efflux reprogramming promotes\n                    <i>Staphylococcus aureus<\/i>\n                    persistence with\n                    <i>Pseudomonas aeruginosa<\/i>\n                    in cystic fibrosis"],"prefix":"10.1128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3275-4360","authenticated-orcid":true,"given":"Q. 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