he development of multidrug resistance in Gram-negative bacteria is a major problem faced antimicrobial therapy and management of infectious diseases. Too many resistance mechanisms were developed since the antimicrobial agents were produced and actually used. The mechanisms involved in antimicrobial agents' resistance are, modifying enzymes, alteration of the target site of antimicrobials and prevention of antimicrobials accumulation inside the bacterial cells. The latest is accomplished by two mechanisms: alteration of outer membrane permeability and efflux pumps. Efflux pumps are either chromosomal or plasmid-encoded although chromosomal encoded efflux pumps are common in Gram-negative bacteria. Resistance nodulation division (RND) efflux pump superfamily are predominant in Gram-negative and involved in pathogenesis, virulence and stress response of bacteria as well as the well …
