Plasmid-encoded resistance to the aminoglycosides gentamicin (Gm), tobramycin (Tm), and kanamycin (Km) (GmTmKmr) In Australian strains of Staphylococcus aureus, resistance to the aminoglycosides gentamicin, tobramycin, and kanamycin (GmTmKmr) has been shown to be encoded on a transposon, Tn4001 (17,18). This composite transposon consists of two inverted copies of the 1.3-kb insertion sequence IS256 flanking a 1.9-kb unique region (5, 17, 24). The resistance aacA-aphD gene is contained within the unique region and codes for production of a 56.9-kDa bifunctional enzyme that specifies aminoglycoside-modifying acetyltransferase AAC(6') and phosphotransferase APH(2") activities (24).Tn4001 is commonly found on members of the pSK1 family of multiresistance plasmids (9,18,28). The majority of these plasmids mediate resistance to acriflavine, ethidium bromide, and quaternary ammonium compounds determined by the qacA gene (31,32). In addition, pSK1-type plasmids may confer resistance to penicillin via production of a P-lactamase carried on Tn4002 (10) and high-level resistance to trimethoprim mediated by a trimethoprim-insensitive dihydrofolate reductase encoded on the putative transposon Tn4003 (25).GmTmKmr in clinical strains of staphylococci from North America is frequently mediated by a group of structurally related plasmids unrelated to the pSK1 family of plasmids found in Australian clinical strains of staphylococci. Many of these plasmids are conjugative (2, 3, 22) and, in addition to GmTmKmr, can specify resistance to other aminoglycosides through 4'-adenyltransferase or 3'-phosphotransferase activities, and they may also mediate resistance to ethidium bromide and quaternary ammonium compounds, penicillin, and trimethoprim (1,2,11,12,14,22 pUW3626 and the related but nonconjugative plasmid pSH6 were isolated from North American clinical strains of S. aureus. Previous molecular studies indicated that these plasmids contained the same GmTmKmr determinant as found in Tn4001 (15). Like Tn4001, the resistance determinants in these plasmids were shown to be flanked by inverted repeats. Although these repeats shared some homology with IS256, they were significantly shorter than the 1.3-kb inverted IS256 elements on Tn400J (15,18,28 (4,25,26). Furthermore, IS257 elements share a significant degree of similarity in both their nucleotide and putative transposase aa sequences with members of the ISI5