“…For example, increasing resistance to penicillin can be achieved by the cooperative interaction of the penA, penB, mtr (multiple transformable resistance), and tem genes (68). A stepwise increase in resistance to ampicillin was observed through the combined effects of four amp alleles, ampA, ampB, ampC and ampD, none of which conferred resistance independently (36). Similarly, a combination of tet, penB, and mtr genes produces a 16-fold increase in tetracycline MICs (68).…”