{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:39:30Z","timestamp":1783348770731,"version":"3.54.6"},"reference-count":65,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>(1) Background: The purpose of the study was to describe the activity of mex efflux pumps in Multidrug-Resistant (MDR) clinical isolates of Pseudomonas aeruginosa and to compare the carbapenem-resistance identification tests with PCR; (2) Methods: Sixty MDR P. aeruginosa were analyzed for detection of carbapenemase by disk diffusion inhibitory method, carbapenem inactivation method and Modified Hodge Test. Endpoint PCR was used to detect 7 carbapenemase genes (blaKPC, blaOXA48-like, blaNDM, blaGES-2, blaSPM, blaIMP, blaVIM) and mcr-1 for colistin resistance. The expression of mexA, mexB, mexC, mexE and mexX genes corresponding to the four main efflux pumps was also evaluated; (3) Results: From the tested strains, 71.66% presented at least one carbapenemase gene, with blaGES-2 as the most occurring gene (63.3%). Compared with the PCR, the accuracy of phenotypic tests did not exceed 25% for P. aeruginosa. The efflux pump genes were present in all strains except one. In 85% of the isolates, an overactivity of mexA, mexB and mostly mexC was detected. Previous treatment with ceftriaxone increased the activity of mexC by more than 160 times; (4) Conclusions: In our MDR P. aeruginosa clinical isolates, the carbapenem resistance is not accurately detected by phenotypic tests, due to the overexpression of mex efflux pumps and in a lesser amount, due to carbapenemase production.<\/jats:p>","DOI":"10.3390\/microorganisms11092211","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T11:33:25Z","timestamp":1693481605000},"page":"2211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Uncovering the Resistance Mechanisms in Extended-Drug-Resistant Pseudomonas aeruginosa Clinical Isolates: Insights from Gene Expression and Phenotypic Tests"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9627-4513","authenticated-orcid":false,"given":"R\u0103zvan Lucian","family":"Co\u0219eriu","sequence":"first","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Delia","family":"Mare","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia","family":"Vintil\u0103","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2262-7456","authenticated-orcid":false,"given":"Cristina Nicoleta","family":"Ciurea","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu Ovidiu","family":"Tog\u0103nel","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0258-0777","authenticated-orcid":false,"given":"Anca","family":"Cighir","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Simion","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5281-0601","authenticated-orcid":false,"given":"Adrian","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"ref_1","unstructured":"Tang, Y.-W., Sussman, M., Liu, D., Poxton, I., and Schwartzman, J.B.T. 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