Relationships between Relative Expression of RND Efflux Pump Genes, H33342 Efflux Activity, Biofilm-Forming Activity, and Antimicrobial Resistance in Acinetobacter baumannii Clinical Isolates.

Various mechanisms underlying antimicrobial resistance in Acinetobacter baumannii have been reported. However, the relationships between efflux pump activity, biofilm formation, and antimicrobial resistance in A. baumannii is controversial. In this study, we investigated the relative expression of RND efflux pump genes, H33342 efflux activity, and biofilm-forming activity in 120 A. baumannii clinical isolates, examined their potential relationships with each other, and statistically analyzed their effects on antibiotic resistance. High adeB expression and high H33342 efflux activity were correlated with low biofilm-forming activity. High adeB expression was significantly correlated with resistance to tigecycline and cefotaxime, but not with the multidrug resistance (MDR) phenotype. Importantly, only high adeJ expression was significantly correlated with the MDR phenotype and was correlated with resistance to various antibiotics. However, we found no significant correlation between adeJ expression and biofilm-forming activity. Furthermore, adeG expression was not correlated with antibiotic resistance and biofilm-forming activity. The results of multivariate analysis showed that adeB overexpression and high H33342 efflux activity were related to biofilm-forming activity, and only adeJ overexpression was significantly associated with the MDR phenotype, highlighting the importance of adeJ overexpression.