Antibiotic-resistant Mutants Research Articles

Spontaneous and evolutionary changes in the antibiotic resistance of Burkholderia cenocepacia observed by global gene expression analysis

BackgroundBurkholderia cenocepacia is a member of the Burkholderia cepacia complex group of bacteria that cause infections in individuals with cystic fibrosis. B. cenocepacia isolate J2315 has been genome sequenced and is representative of a virulent, epidemic CF strain (ET12). Its genome encodes multiple antimicrobial resistance pathways and it is not known which of these is important for intrinsic or spontaneous resistance. To map these pathways, transcriptomic analysis was performed on: (i) strain J2315 exposed to sub-inhibitory concentrations of antibiotics and the antibiotic potentiator chlorpromazine, and (ii) on spontaneous mutants derived from J2315 and with increased resistance to the antibiotics amikacin, meropenem and trimethoprim-sulfamethoxazole. Two pan-resistant ET12 outbreak isolates recovered two decades after J2315 were also compared to identify naturally evolved gene expression changes.ResultsSpontaneous resistance in B. cenocepacia involved more gene expression changes and different subsets of genes than those provoked by exposure to sub inhibitory concentrations of each antibiotic. The phenotype and altered gene expression in the resistant mutants was also stable irrespective of the presence of the priming antibiotic. Both known and novel genes involved in efflux, antibiotic degradation/modification, membrane function, regulation and unknown functions were mapped. A novel role for the phenylacetic acid (PA) degradation pathway genes was identified in relation to spontaneous resistance to meropenem and glucose was found to repress their expression. Subsequently, 20 mM glucose was found to produce greater that 2-fold reductions in the MIC of multiple antibiotics against B. cenocepacia J2315. Mutation of an RND multidrug efflux pump locus (BCAM0925-27) and squalene-hopene cyclase gene (BCAS0167), both upregulated after chlorpromazine exposure, confirmed their role in resistance. The recently isolated outbreak isolates had altered the expression of multiple genes which mirrored changes seen in the antibiotic resistant mutants, corroborating the strategy used to model resistance. Mutation of an ABC transporter gene (BCAS0081) upregulated in both outbreak strains, confirmed its role in B. cenocepacia resistance.ConclusionsGlobal mapping of the genetic pathways which mediate antibiotic resistance in B. cenocepacia has revealed that they are multifactorial, identified potential therapeutic targets and also demonstrated that putative catabolite repression of genes by glucose can improve antibiotic efficacy.

Dynamics of Antibiotic Resistant Mycobacterium tuberculosis during Long-Term Infection and Antibiotic Treatment

For an infecting bacterium the human body provides several potential ecological niches with both internally (e.g. host immunity) and externally (e.g. antibiotic use) imposed growth restrictions that are expected to drive adaptive evolution in the bacterium, including the development of antibiotic resistance. To determine the extent and pattern of heterogeneity generated in a bacterial population during long-term antibiotic treatment, we examined in a monoclonal Mycobacterium tuberculosis infection antibiotic resistant mutants isolated from one patient during a 9-years period. There was a progressive accumulation of resistance mutations in the infecting clone. Furthermore, apparent clonal sweeps as well as co-existence of different resistant mutants were observed during this time, demonstrating that during treatment there is a high degree of dynamics in the bacterial population. These findings have important implications for diagnostics and treatment of drug resistant tuberculosis infections.

Application of high hydrostatic pressure to decontaminate green onions from Salmonella and Escherichia coli O157:H7

Consumption of fecally contaminated green onions has been implicated in several major outbreaks of foodborne illness. The objectives of this study were to investigate the survival and growth of Salmonella and Escherichia coli O157:H7 in green onions during storage and to assess the application of high hydrostatic pressure (HHP) to decontaminate green onions from both pathogens. Bacterial strains resistant to nalidixic acid and streptomycin were used to inoculate green onions at low (∼1logcfu/g) and high (∼2logcfu/g) inoculum levels which were then kept at 4 or 22°C for up to 14 days. Both pathogens grew to an average of 5–6logcfu/g during storage at 22°C and the bacterial populations were fairly stable during storage at 4°C. High-pressure processing of inoculated green onions in the un-wetted, wetted (briefly dipped in water) or soaked (immersed in water for 30min) conditions at 250–500MPa for 2min at 20°C reduced the population of Salmonella and E. coli O157:H7 by 0.6 to >5logcfu/g, depending on the pressure level and sample wetness state. The extent of pressure inactivation increased in the order of soaked>wetted>un-wetted state. The pressure sensitivity of the pathogens was also higher at elevated treatment temperatures. Overall, after pressure treatment at 400–450MPa (soaked) or 450–500MPa (wetted) for a retention time of 2min at 20–40°C, wild-type and antibiotic-resistant mutant strains of Salmonella and E. coli O157:H7 inoculated on green onions were undetectable immediately after treatment and throughout the 15-day storage at 4°C. The pressure treatments also had minimal adverse impact on most sensorial characteristics as well as on the instrumental color of chopped green onions. This study highlights the promising applications of HHP to minimally process green onions in order to alleviate the risks of Salmonella and E. coli O157:H7 infections associated with the consumption of this commodity.

Respiration-deficient mutants of Zymomonas mobilis show improved growth and ethanol fermentation under aerobic and high temperature conditions

Respiration-deficient mutant (RDM) strains of Zymomonas mobilis were isolated from antibiotic-resistant mutants. These RDM strains showed various degrees of respiratory deficiency. All RDM strains exhibited much higher ethanol fermentation capacity than the wild-type strain under aerobic conditions. The strains also gained thermotolerance and exhibited greater ethanol production at high temperature (39°C), under both non-aerobic and aerobic conditions, compared with the wild-type strain. Microarray and subsequent quantitative PCR analyses suggest that enhanced gene expression involved in the metabolism of glucose to ethanol resulted in the high ethanol production of RDM strains under aerobic growth conditions. Reduction of intracellular oxidative stress may also result in improved ethanol fermentation by RDM strains at high temperatures.

Effect of recA inactivation on mutagenesis of Escherichia coli exposed to sublethal concentrations of antimicrobials

Low concentrations of some antibiotics have been reported to stimulate mutagenesis and recombination, which may facilitate bacterial adaptation to different types of stress, including antibiotic pressure. However, the mutagenic effect of most of the currently used antibiotics remains untested. Furthermore, it is known that in many bacteria, including Escherichia coli, stimulation of mutagenesis is mediated by the SOS response. Thus, blockage or attenuation of this response through the inhibition of RecA has been proposed as a possible therapeutic adjuvant in combined therapy to reduce the ability to generate antibiotic-resistant mutants. The aim of this work was to study the capacity of sublethal concentrations of antimicrobials of different families with different molecular targets to increase the mutant frequency of E. coli, and the effect that inactivation of recA would have on antibiotic-mediated mutagenesis. We tested the mutagenicity of the following antimicrobials: ampicillin; ceftazidime; imipenem; fosfomycin; ciprofloxacin; trimethoprim; sulfamethoxazole; trimethoprim/sulfamethoxazole; colistin; tetracycline; gentamicin; rifampicin; and chloramphenicol. Eight out of the 13 antimicrobials tested stimulate E. coli mutagenesis (slightly in most cases), with trimethoprim, alone or in combination with sulfamethoxazole, producing the highest effect. Inactivation of recA abolishes the mutagenic effect and also produces increased susceptibility to some of the tested antimicrobials. The fact that inactivation of recA reduces mutagenicity and/or increases the activity of a large number of antimicrobials supports the hypothesis that RecA inhibition might have favourable effects on antibiotic therapy.

Identification of differences in virulence factors production from mutant isolates of clinical Vibrio cholerae S

Antibiotic resistant mutants for rifampicin, streptomycin and klindamycin were isolated from the clinical isolate of Vibrio choleraeS mutated by chemical mutagens. Mutation frequency of V. cholerae S depends on the treatment time and the highest viable count of antibiotic resistant were for Rifampicin after treatment with Acridine orange, Ethedium bromide, Nitrosoguanidine, 5-Florouracil, 2-Bromouracil and cyclophosphamide. One thousand mutant isolates were examined for morphological differences in colony surface, color and diameter. The treatment with AO, NTG, 5-FU, and 2-BU gave opaque to orange color larger diameter about 5-7 mm of Rifampicin resistant mutant isolates at TSA and 25% of these mutant appeared as wrinkled surface. Klindamycin resistant mutants of V. cholerae S were appeared as similar to the wild type while, Streptomycin resistant mutants of appeared as pin- point white smooth colonies on TSA. No differences were seen for oxidase, string test and fermentation pattern for sucrose and lactose. Toxin CoregulatedPili production was differed from high level order designated as +++ to mild ++ and low level designated as + after mutation with 5-FU and 2-BU. However, 15% of rifampicin resistant mutant isolates gave no agglutination phenomena. No proteases activity detected even after 48 hour of incubation; the production of lipases enzyme did not affected; while, mutator isolates produced high level of β- haemolysins about 2.5 fold. About 90% of cyclophosphamide- rifampicin mutant showed homogenized culture with no auto agglutination but high level of proteases. While, only 10% of cyclophosphamide - rifampicin mutants gave slightly auto agglutination and didn’t produce proteases enzyme. The production of both TCP and CT were increased from rough pigment producing mutant isolates comparing with yellow and smooth mutants.

Streptomycetes are special: arcane applications

Streptomycetes are special: arcane applications

The joys and terrors of fast adaptation: new findings elucidate antibiotic resistance and natural selection

Experiments of Pränting and Andersson demonstrate how bacteria adapt to the growth limitation caused by antibiotic resistance mutations. The process of adaptation relies on gene copy number changes that arise at high rates, including duplications (10(-4) per cell per generation), amplifications (10(-2) per cell per generation) and mutant copy loss (10(-2) per cell per division). Reversible increases in copy number improve growth by small steps and provide more targets for rare sequence alterations (10(-9) per cell per division) that can stably improve growth. After sequence alteration, selection favours loss of the still mutant gene copies that accelerated adaptation. The results strongly support the amplification-reversion model for fast adaptation and argue against the alternative idea of 'stress-induced mutagenesis'.

Antibiotic resistant mutants of Escherichia coli K12 show increases in heterologous gene expression

Using a variety of antibiotics, it was found that nine separate isolates of spontaneous antibiotic resistant mutants of Escherichia coli K12 pPSX- vioABCDE overproduce the anti-tumour antibiotic violacein. Subsequent analysis showed that seven of these mutations occurred on the plasmid pPSX- vioABCDE. The other two overproducing strains carried spontaneous chromosomal mutations to lincomycin and kanamycin. The kanamycin resistant mutant of E. coli K12 DH10B (AA23) and a lincomycin resistant mutant of E. coli K12 LE392 (AA24) increased the synthesis of violacein. The plasmid pPSX- vioABCDE opv-1 contains a violacein over-production ( opv-1) mutation which when introduced into either E. coli K12 AA23 or AA24, resulted in a hyper-production of violacein. Remarkably, E. coli K12 AA23 pPSX- vioABCDE opv-1 produced 41 times the normal level of violacein. In addition, both E. coli K12 AA23 and E. coli K12 AA24 demonstrated an increase in expression of an alpha amylase gene from Streptomyces lividans and the urease gene cluster from Klebsiella oxytoca. These results suggest that selection of antibiotic resistant mutants can increase heterologous gene expression in E. coli K12. Additionally, the increased expression is a general effect applicable to genes and gene clusters cloned into E. coli K12 from both Gram-positive and Gram-negative bacteria.

Differences in the In Vitro Susceptibility of Planktonic and Biofilm-Associated Escherichia Coli Strains to Antimicrobial Agents

The In Vitro susceptibility of seven Escherichia Coli biofilm-producing strains in their planktonic and biofilmassociated forms to amoxicillin, amoxicillin/clavulanic acid, cefotaxime, gentamicin, and ciprofloxacin was studied. Minimum inhibitory concentrations (MICs) were determined by the standard microdilution method and by the Alamar blue assay (providing the AB-MIC) at two levels of metabolic suppression and using standard and large inocula. Minimal biofilm inhibitory concentrations (AB-MBICs) on preformed biofilms on polystyrene plates were higher than the MICs and AB-MICs. Differences in magnitude depended on the antibiotic, strain, inoculum size, and the level of suppression of metabolism. Ciprofloxacin and gentamicin showed the greatest differences in the AB-MBIC as compared to AB-MIC. The possibility of antibiotic-resistant mutant selection within the biofilms was ruled out since bacteria recovered from the biofilm maintained the same MICs as before exposure to the antimicrobial agents. E. coli biofilms were much less sensitive than their planktonic counterparts.

Chloramphenicol acetyltransferase as selectable marker for plastid transformation

Chloroplast transformation remains a demanding technique and is still restricted to relatively few plant species. The limited availability of selectable marker genes and the lack of selection markers that would be universally applicable to all plant species represent some of the most serious technical problems involved in extending the species range of plastid transformation. Here we report the development of the chloramphenicol acetyltransferase gene cat as a new selectable marker for plastid transformation. We show that, by selecting for chloramphenicol resistance, tobacco chloroplast transformants are readily obtained. Transplastomic lines quickly reach the homoplasmic state (typically in one additional regeneration round), accumulate the chloramphenicol acetyltransferase enzyme to high levels and transmit their plastid transgenes maternally into the next generation. No spontaneous antibiotic resistance mutants appear upon chloramphenicol selection. Several lines of evidence support the assumption that plant mitochondria are also sensitive to chloramphenicol suggesting that the chloramphenicol acetyltransferase may be a good candidate selectable marker for plant mitochondrial transformation.

A 96-well plate fluorescence assay for assessment of cellular permeability and active efflux in Salmonella enterica serovar Typhimurium and Escherichia coli

Multiply antibiotic-resistant (MAR) mutants of Escherichia coli and Salmonella enterica are characterized by reduced susceptibility to several unrelated antibiotics, biocides and other xenobiotics. Porin loss and/or active efflux have been identified as a key mechanisms of MAR. A single rapid test was developed for MAR. The intracellular accumulation of the fluorescent probe Hoechst (H) 33342 (bisbenzimide) by MAR mutants and those with defined disruptions in efflux pump and porin genes was determined in 96-well plate format. The accumulation of H33342 was significantly (P < 0.0001) reduced in MAR mutants of S. enterica serovar Typhimurium (n = 4) and E. coli (n = 3) by 41 +/- 8% and 17.3 +/- 7.2%, respectively, compared with their parental strains, which was reversed by the transmembrane proton gradient-collapsing agent carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) and the efflux pump inhibitor phenylalanine-arginine-beta-naphthylamide (PA beta N). The accumulation of H33342 was significantly reduced in mutants of Salmonella Typhimurium with defined disruptions in genes encoding the porins OmpC, OmpF, OmpX and OmpW, but increased in those with disruptions in efflux pump components TolC, AcrB and AcrF. Reduced accumulation of H33342 in three other MAR mutants of Salmonella Typhimurium correlated with the expression of porin and efflux pump proteins. The intracellular accumulation of H33342 provided a sensitive and specific test for MAR that is cheap and relatively rapid. Differential sensitivity to CCCP and PA beta N provided a further means to phenotypically identify MAR mutants and the role of active efflux in each strain.

Compensation of Fitness Costs and Reversibility of Antibiotic Resistance Mutations

Strains of bacterial pathogens that have acquired mutations conferring antibiotic resistance often have a lower growth rate and are less invasive or transmissible initially than their susceptible counterparts. However, fitness costs of resistance mutations can be ameliorated by secondary site mutations. These so-called compensatory mutations may restore fitness in the absence and/or presence of antimicrobials. We review literature data and show that the fitness gains in the absence and presence of antibiotic treatment need not be correlated. The aim of this study is to gain a better conceptual grasp of how compensatory mutations with different fitness gains affect evolutionary trajectories, in particular reversibility. To this end, we developed a theoretical model with which we consider both a resistance and a compensation locus. We propose an intuitively understandable parameterization for the fitness values of the four resulting genotypes (wild type, resistance mutation only, compensatory mutation only, and both mutations) in the absence and presence of treatment. The differential fitness gains, together with the turnover rate and the mutation rate, strongly affected the success of antibacterial treatment, reversibility, and long-term abundance of resistant strains. We therefore propose that experimental studies of compensatory mutations should include fitness measurements of all possible genotypes in both the absence and presence of an antibiotic.

Mutant prevention concentrations of fluoroquinolones against Campylobacter jejuni isolated from chicken

The mutant prevention concentration (MPC) and mutant selection window (MSW) concepts have been used to evaluate antibiotic concentration ranges that prevent the emergence of antibiotic resistant mutants. Campylobacter jejuni is highly mutable to fluoroquinolone (FQ) antibiotics, but it is unknown if the MPC concept can be used to prevent mutant emergence. In this study, the MPCs of three FQs including enrofloxacin, norfloxacin and ciprofloxacin were determined using 13 C. jejuni isolates. Also, first- and second-step FQ-resistant mutants were selected and the mutations in gyrA and gyrB as well as the contribution of efflux pump to FQ resistance were investigated. The MICs of all selected mutants were determined in the presence or absence of the efflux pump inhibitors carbonyl cyanide 3-chlorophenylhydrazone (CCCP) and reserpine. Our results revealed that the three tested FQs had different MPC ranges and the MPC order was norfloxacin > ciprofloxacin > enrofloxacin, suggesting a better in vitro efficacy of enrofloxacin over ciprofloxacin and norfloxacin in reducing the emergence of C. jejuni mutants. The results also confirmed the single-step mechanism of acquired FQs resistance in C. jejuni mutants. Both point mutations (Thr-86-Ile and Asp-90-Asn) in the gyrA gene and the function of efflux pumps contributed to the acquired resistance to ciprofloxacin and norfloxacin, while gyrA mutations (Thr-86-Ile and Asp-90-Asn) were the main mechanism for enrofloxacin resistance. These findings provide new insights into the development and mechanisms of FQ resistance in Campylobacter.

Mutation frequency in antibiotic-resistant and -susceptible isolates of Streptococcus pneumoniae

Development of multiple antibiotic resistance in Streptococcus pneumoniae typically involves either mutation or transformation at several well-separated chromosomal loci. We postulated that this series of genetic events would be more likely to occur in organisms with deficient DNA repair mechanisms. Investigation of 27 antibiotic-resistant or -susceptible clinical isolates of S. pneumoniae revealed a broad range of mutation frequencies, but no isolate was as mutable as a mismatch repair (MMR)-deficient laboratory isolate. No correlation was observed between antibiotic resistance and higher mutation frequency. Examination of a further 180 clinical isolates using a newly developed rapid screen method also failed to identify any isolates with a mutation frequency as high as the MMR-deficient control strain. We argue that there is currently no clear evidence of a distinct population of mutators among clinical pneumococci.

Screening for fluorescent pseudomonades, isolated from the rhizosphere of tomato, for antagonistic activity toward Clavibacter michiganensis subsp. michiganensis

Bacterial canker of tomato, caused by Clavibacter michiganensis subsp. michiganensis, continues to be a problem for tomato growers in the Souss-Massa Draa valley, South of Morocco. Assuming that biological control is an alternative for the management of this disease, a total of 303 fluorescent pseudomonads strains isolated from roots and rhizospheric soil of tomato plants were in vitro tested against C. michiganensis subsp. michiganensis. Fluorescent pseudomonads strains which showed the highest antagonistic properties were thereafter investigated for their ability to colonize tomato roots. Our results showed that fluorescent pseudomonads are more represented in rhizospheric soils. However, the most efficient fluorescent pseudomonads isolates were found in the rhizoplane soil and the endorhizosphere. Among 42 spontaneous antibiotic resistant mutants obtained by treatment of the wild-type isolates with five antibiotics (rifampicine, nalidixic acid, ampicilline and chloramphenicol), 28 completely colonized the roots of all tomatoes seedlings used in this investigation. The 42 wild type isolates were then used for in vivo screening with the cotyledon test. Using this test, eight isolates from 42 tested induced a significant decrease of disease incidence and disease symptoms. The eight efficient isolates were then tested for their effectiveness in the protection of tomato plants in pots under greenhouse conditions. Results obtained showed that all tested isolates applied as seed and root treatments reduced significantly (P ≤ 0.001) the incidence of bacterial canker.

Different effects of transcriptional regulators MarA, SoxS and Rob on susceptibility of Escherichia coli to cationic antimicrobial peptides (CAMPs): Rob-dependent CAMP induction of the marRAB operon.

Cationic antimicrobial peptides (CAMPs), a component of the mammalian immune system, protect the host from bacterial infections. The roles of the Escherichia coli transcriptional regulators MarA, SoxS and Rob in susceptibility to these peptides were examined. Overexpression of marA, either in an antibiotic-resistant marR mutant or from a plasmid, decreased bacterial susceptibility to CAMPs. Overexpression of the soxS gene from a plasmid, which decreased susceptibility to antibiotics, unexpectedly caused no decrease in CAMP susceptibility; instead it produced increased susceptibility to different CAMPs. Deletion or overexpression of rob had little effect on CAMP susceptibility. The marRAB operon was upregulated when E. coli was incubated in sublethal amounts of CAMPs polymyxin B, LL-37 or human beta-defensin-1; however, this upregulation required Rob. Deletion of acrAB increased bacterial susceptibility to polymyxin B, LL-37 and human beta-defensin-1 peptides. Deletion of tolC yielded an even greater increase in susceptibility to these peptides and also led to increased susceptibility to human alpha-defensin-2. Inhibition of cellular proton-motive force increased peptide susceptibility for wild-type and acrAB deletion strains; however, it decreased susceptibility of tolC mutants. These findings demonstrate that CAMPs are both inducers of marA-mediated drug resistance through interaction with Rob and also substrates for efflux in E. coli. The three related transcriptional regulators show different effects on bacterial cell susceptibility to CAMPs.

The initial adsorption of T4 bacteriophages to Escherichia coli cells at equivalent concentrations: Experiments and mathematical modeling

The emergence of antibiotic-resistant mutants among pathogenic bacteria has re-focused interest in alternative antibacterial treatments such as “phage therapy”, where viruses are harnessed to infect and destroy bacteria included in their host range. The first stage in bacteriophage multiplication, its adsorption to the bacterial cell surface, has not been accurately resolved before. Previous studies focused on very low phage-to-bacteria concentration ratios. In this study, detailed kinetics of T4 adsorption to Escherichia coli B/r were obtained with high sampling frequency during the first 6 min, with suspensions of nearly the same initial number of phages and bacteria. The results were used to analyze several optional models and to choose the most suitable, based on simplicity and best fit to the data. It was found that simple, mono-attachment models adequately fit the experimental data.

Mutational Upregulation of a Resistance-Nodulation-Cell Division-Type Multidrug Efflux Pump, SdeAB, upon Exposure to a Biocide, Cetylpyridinium Chloride, and Antibiotic Resistance in Serratia marcescens

Serratia marcescens is an important opportunistic pathogen in hospitals, where quaternary ammonium compounds are often used for disinfection. The aim of this study is to elucidate the effect of a biocide on the emergence of biocide- and antibiotic-resistant mutants and to characterize the molecular mechanism of biocide resistance in Serratia marcescens. A quaternary ammonium compound-resistant strain, CRes01, was selected by exposing a wild-type strain of S. marcescens to cetylpyridinium chloride. The CRes01 cells exhibited 2- to 16-fold more resistance than the wild-type cells to biocides and antibiotics, including cetylpyridinium chloride, benzalkonium chloride, chlorhexidine gluconate, fluoroquinolones, tetracycline, and chloramphenicol, and showed increased susceptibilities to beta-lactam antibiotics and N-dodecylpyridinium iodide. Mutant cells accumulated lower levels of norfloxacin than the parent cells in an energized state but not in a de-energized state, suggesting that the strain produced a multidrug efflux pump(s). To verify this assumption, we knocked out a putative efflux pump gene, sdeAB, in CRes01 and found that the knockout restored susceptibility to most quaternary ammonium compounds and antibiotics, to which the CRes01 strain showed resistance. On the basis of these and other results, we concluded that S. marcescens gains resistance to both biocides and antibiotics by expressing the SdeAB efflux pump upon exposure to cetylpyridinium chloride.

Positive Epistasis Drives the Acquisition of Multidrug Resistance

The evolution of multiple antibiotic resistance is an increasing global problem. Resistance mutations are known to impair fitness, and the evolution of resistance to multiple drugs depends both on their costs individually and on how they interact—epistasis. Information on the level of epistasis between antibiotic resistance mutations is of key importance to understanding epistasis amongst deleterious alleles, a key theoretical question, and to improving public health measures. Here we show that in an antibiotic-free environment the cost of multiple resistance is smaller than expected, a signature of pervasive positive epistasis among alleles that confer resistance to antibiotics. Competition assays reveal that the cost of resistance to a given antibiotic is dependent on the presence of resistance alleles for other antibiotics. Surprisingly we find that a significant fraction of resistant mutations can be beneficial in certain resistant genetic backgrounds, that some double resistances entail no measurable cost, and that some allelic combinations are hotspots for rapid compensation. These results provide additional insight as to why multi-resistant bacteria are so prevalent and reveal an extra layer of complexity on epistatic patterns previously unrecognized, since it is hidden in genome-wide studies of genetic interactions using gene knockouts.