Extended-spectrum β-lactamase (ESBL)-producing gram-negative organisms are an increasing cause of healthcare-associated infections. Escherichia coli, Klebsiella pneumoniae, and Proteus spp. are the most common ESBL-producing pathogens recognized in the United States (1). The widespread use of oxyimino-cephalosporins, which were introduced in the 1980s to treat antibiotic-resistant bacteria, is believed to be a major contributor to the emergence of ESBL-producing organisms. ESBL-producing organisms are able to hydrolyze oxyimino-cephalosporins and monobactams (Scheme 1, top); moreover, ESBL-producing organisms are generally resistant to aminoglycosides because the bla genes that encode for ESBLs are carried on mobile elements that also carry other antibiotic resistance factors, such as genes encoding aminoglycoside-modifying enzymes. As a result, it is necessary for clinical laboratories to detect the production of ESBLs in order for clinicians to initiate appropriate antibiotic therapy (2). Carbapenems (imipenem, meropenem, ertapenem, and doripenem) are stable against hydrolysis by ESBLs and are regarded as the “drugs of choice” for infections due to ESBL-producing organisms (3, 4). Scheme 1 No caption. The first plasmid-mediated β-lactamase capable of hydrolyzing extended-spectrum cephalosporins, now known as SHV-2, was reported in 1983 and a number of other groups of β-lactamases with expanded hydrolytic activity were reported thereafter (5, 6). The term ‘extended-spectrum β-lactamase’ (ESBL) was applied to denote these enzymes with activity against extended-spectrum cephalosporins, such as cefotaxime, ceftazidime (Scheme 1), ceftriaxone, and cefuroxime (7-9). Sequencing of the encoding genes revealed that most ESBLs described in the 1980s were derived from genes for blaTEM-1 or blaSHV-1 by mutations that alter the architecture of the active site. The current emergence of CTX-M type ESBLs, β-lactamases whose substrate profile favors either cefotaxime or ceftazidime hydrolysis, are also becoming an international problem (4, 10, 11). The latter family of ESBLs is now found in many isolates of E. coli found in community acquired urinary tract infections. In both SHV and TEM backgrounds, the G238S substitution is critical for cefotaxime hydrolysis whereas both the G238S/E240K substitutions are needed for clinically-significant ceftazidime hydrolysis (12, 13). Overlay of either the SHV G238S or the TEM G238S crystal structure with the respective WT crystal structure shows a significant 1-3 A displacement in the 238–242 β-strand-turn segment, which allows the β-lactam binding site to accommodate oxyimino-cephalosporins with large C7 groups, thereby expanding the substrate spectrum of the variant enzyme (14, 15). The E240K substitution is only observed in concert with G238S or R164S and confers enhanced ability to hydrolyze ceftazidime and aztreonam, which both possess a bulky 1-carboxy-1-methylethoxyimino side chain (highlighted in Scheme 1). Unlike the G238S substitution, structural data is not available for either TEM or SHV with E240K; however, molecular modeling suggests that the lysine side chain is able to form an electrostatic bond with the carboxylic acid of the oxyimino substituent (highlighted in Scheme 1) (13). If residue 240 is glutamate, as in WT or G238S, its carboxylic acid group encounters the oxime's carboxylic acid group. Consequently, the electrostatic repulsion results in little catalytic activity against either ceftazidime or aztreonam (13). Another distinguishing and un-explained attribute of ESBLs is their “hyper-susceptibility” to mechanism-based inhibitors, such as sulbactam, tazobactam, and clavulanic acid (Scheme 1, bottom) (16). Following an attack on the β-lactam carbonyl by the S70 side-chain, the resultant acyl-enzyme undergoes a series of proton transfers in which a variety of intermediates, including imine 1, cis-enamine 2,trans-enamine 3, and irreversible S130-bound acrylate (not shown), are possible (see Scheme 2). Mechanistically, the linear trans-enamine intermediate is a long-lived inhibitory species (17-19). Consequently, the “hyper-susceptibility” of SHV-type ESBLs, compared to the WT enzyme, may arise from relative or absolute differences in the amount of trans-enamine formed by a given inhibitor. Previous Raman/X-ray analysis of an inhibitor-resistant β-lactamase showed that addition of the resistant mutation M69V to an E166A background reduced the amount of trans-enamine seen with tazobactam and clavulanic acid (20). While significant structural changes were not seen in the binding of the trans-enamine intermediate once it was formed, X-ray crystallography detected a slightly smaller oxyanion hole for the M69V/E166A variant (20). In this work, potential differences in inhibitory population levels are explored in single crystals of SHV-2 or -5 by Raman microscopy, which detects higher relative amounts of the trans-enamine acyl-enzyme compared to SHV-1. Additionally, UV spectroscopy in solution shows that, under single turnover conditions, SHV-2 and SHV-5 make approximately 35% more of an enamine-type species than SHV-1. Higher populations of the trans-enamine intermediate result in lower KI values and greater inactivation efficiencies for the mechanism-based inhibitors compared to the WT enzyme. Together, the data explain the observed in vivo and in vitro “hyper-susceptibility” of ESBLs harboring mutations in the key β-strand of the catalytic site of class A β-lactamases. Scheme 2 Reaction scheme for sulbactam and serine-70 in the active site of a β-lactamase. “1” is an imine, and “2” and “3” are cis- and trans-enamines, respectively. In addition to deacylation the imine ( ...