In order to compare patterns of resistance to inhibition by clavulanic acid with patterns of resistance to inhibition by a -lactamase inhibitor protein (BLIP), R164S, R244S, and R164S/R244S mutant forms of TEM -lactamase were prepared by site-directed mutagenesis. When kinetic parameters were determined for these mutant and wild-type forms of TEM, the single mutants showed properties that were similar to those in the literature but the double mutant showed properties that were very different. The R164S/R244S double mutant form of TEM retained its resistance to inhibition by clavulanic acid (characteristic of the R244S mutation) but lost all its ability to hydrolyze ceftazidime (characteristic of the R164S mutation). While these characteristics are contrary to those previously reported for an R164S/R244S double mutant, this discrepancy resulted from the use of a defective mutant in the earlier study. Both the single and double mutant forms of TEM remained highly sensitive when tested for inhibition by BLIP, showing only slightly increased resistance compared to that of the wild type; this pattern of resistance is quite different from the pattern of clavulanic acid resistance. The slight increases in resistance to inhibition by BLIP seen in the mutants may have been related to the fact that all of the mutations effected changes in the net charge on the TEM protein that could impede interactions with BLIP.Bacterial resistance to antibiotics is an important and growing concern in the treatment of infectious diseases. Although -lactam compounds still compose more than 50% of all prescribed antibiotics, the development of resistant strains represents a serious threat to the continued usefulness of these agents. In particular, the emergence of mutant forms of the -lactamase TEM, the single most prevalent -lactamase found in gram-negative bacteria, provides a striking example of the evolution of antibiotic resistance. In response to the appearance of microbial resistance mediated by TEM and other -lactamases, aminothiazole oxime-containing, -lactamaseresistant antibiotics such as ceftazidime, cefotaxime, and aztreonam were developed. As an alternative approach, -lactamase inhibitors used in combination with conventional penicillins and cephalosporins were also introduced. However, the advent of each new control strategy was met with the emergence of mutant forms of TEM that are resistant to the new agent. The number of naturally occurring mutant forms of TEM now exceeds 100 (http://www.lahey.org/studies/temtable .htm). Although there are many examples of TEM mutants showing activity against extended-spectrum cephalosporins, and others that are insensitive to inhibition by clavulanic acid (3-6, 10, 12, 14; D. Sirot, C. Chanal, R. Bonnet, C. DeChamps, and J. Sirot, Letter, Antimicrob. Agents Chemother. 45:2179-2180, 2001), the coexistence of mutations associated with these resistance characteristics within a single enzyme is less common and typically results in the loss of one phenotype or the other (9, 13, 18). T...