Alterations in gene expression of and in antibiotic-resistant .

is a critical pathogen with an efficient SOS (Save Our Ship) system that plays a significant role in antibiotic resistance. This prospective descriptive study aimed to investigate the association between expression levels of and genes, which are critical in SOS pathways, and antibiotic resistance in . We analyzed 78 clinical isolates and 31 ecological isolates using the Vitek-2 system for bacterial identification and antibiotic susceptibility testing and confirmed molecular identification of by conventional PCR of bla and bla. Quantitative real-time polymerase chain reaction was used to determine gene expression levels of and . The results showed that in 25 clinical strains, 14/25 strains showed upregulation of , 7/25 strains exhibited upregulation of both and , and 1/25 strains showed upregulation of . Of these, 16/25 clinical strains were extensively resistant to antibiotics, except for colistin, and showed upregulation of and/or gene expression levels. In 6 ecological strains, showed upregulation in 3/6 strains, while both and were upregulated in 1/6 strain. In conclusion, high expression levels of and/or genes in complex and strains may contribute to increasing resistance to a wide range of antibiotics and may result in the initiation of an extensively drug-resistant (XDR) phenotype.