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Lipid A modification and other mechanisms of resistance in Gram-negative bacteria Modifications of LPS structure Gram-negative bacteria have developed multiple mechanisms of resistance to various antibiotics, including capsule formation, LPS loss, lipid A modification, the activation of efflux pumps, biofilm formation, target-site mutations, changes in the cell morphology, and the production of hydrolytic enzymes [45, 46, 47, 48, 49]