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Efflux pump is believed to play an important role in mediating drug resistance. The current study examined the potential of efflux pump inhibitors to reverse levofloxacin (LFX) resistance in\n              <jats:italic>M. abscessus<\/jats:italic>\n              . The reference strain of\n              <jats:italic>M. abscessus<\/jats:italic>\n              (ATCC19977) and 60 clinical isolates, including 41\n              <jats:italic>M. abscessus<\/jats:italic>\n              subsp.\n              <jats:italic>abscessus<\/jats:italic>\n              and 19\n              <jats:italic>M<\/jats:italic>\n              .\n              <jats:italic>abscessus<\/jats:italic>\n              subsp.\n              <jats:italic>massilense<\/jats:italic>\n              , were investigated. The drug sensitivity of\n              <jats:italic>M. abscessus<\/jats:italic>\n              against LFX alone or in conjunction with efflux pump inhibitors, including verapamil (VP), reserpine (RSP), carbonyl cyanide 3-chlorophenylhydrazone (CCCP), or dicyclohexylcarbodiimide (DCC), were determined by AlarmarBlue microplate assay. Drug-resistant regions of the\n              <jats:italic>gyrA<\/jats:italic>\n              and\n              <jats:italic>gyrB<\/jats:italic>\n              genes from the drug-resistant strains were sequenced. The transcription level of the efflux pump genes was monitored using qRT-PCR. All the tested strains were resistant to LFX. The drug-resistant regions from the\n              <jats:italic>gyrA<\/jats:italic>\n              and\n              <jats:italic>gyrB<\/jats:italic>\n              genes showed no mutation associated with LFX resistance. CCCP, DCC, VP, and RSP increased the susceptibility of 93.3% (56\/60), 91.7% (55\/60), 85% (51\/60), and 83.3% (50\/60) isolates to LFX by 2 to 32-fold, respectively. Elevated transcription of seven efflux pump genes was observed in isolates with a high reduction in LFX MIC values in the presence of efflux pump inhibitors. Efflux pump inhibitors can improve the antibacterial activity of LFX against\n              <jats:italic>M. abscessus in vitro<\/jats:italic>\n              . The overexpression of efflux-related genes in LFX-resistant isolates suggests that efflux pumps are associated with the development of LFX resistance in\n              <jats:italic>M. abscessus<\/jats:italic>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/aac.01348-23","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T12:42:05Z","timestamp":1712234525000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":7,"title":["Efflux pump effects on levofloxacin resistance in\n            <i>Mycobacterium abscessus<\/i>"],"prefix":"10.1128","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5485-5018","authenticated-orcid":false,"given":"Tianlu","family":"Teng","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor 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