Several drug resistances in Streptococcus pneumoniae are associated with mobile genetic elements, which are loosely subdivided into a group of smaller (18-to 27-kb) and a group of larger (>50-kb) elements. While the elements of the former group, which typically carry the tetracycline resistance determinant tet(M) and whose prototype is Tn916 (18 kb), have been studied extensively, the larger elements, whose prototype is Tn5253 (ϳ65.5 kb), are not as well explored. Tn5253 is a composite structure consisting of two independent conjugative transposons, Tn5251 (which is virtually identical to Tn916) and Tn5252 (ϳ47.5 kb), with the former inserted into the latter. Tn5252, which so far has only partially been sequenced, carries an integrase gene, driving its site-specific insertion into the host cell genome, and the chloramphenicol resistance cat pC194 determinant. This study investigated 20 clinical isolates of S. pneumoniae, which were selected on the basis of cat pC194 -mediated chloramphenicol resistance. All 20 isolates harbored a Tn5253-like element. The composite elements (some of which have been completely sequenced) demonstrated considerable heterogeneity that stemmed from a dual variability: in the Tn5252-like element, due primarily to differences in the integrase gene but also to differences in cargo genes and in the overall genetic organization, and in the Tn916-like element, with the possible involvement, besides Tn916, of a number of Tn916 family pneumococcal elements carrying different erythromycin resistance genes. In mating experiments, only one composite element, containing a less typical Tn916 family element, appeared to be nonmobile. Being part of a Tn5253-like composite element may confer on some Tn916-like transposons, which are apparently nontransferable as independent genetic elements, the ability to be mobilized.A unique recombination-mediated genetic plasticity is a distinctive feature of Streptococcus pneumoniae (3) and a key to its success as a pathogen. In this context, a cause for serious concern is the emergence and increasing spread of multidrugresistant clinical pneumococci (28), where multiple resistance is generally associated with mobile genetic elements. Although the nomenclature for such elements is evolving, they are often referred to as transposons or as integrative and conjugative elements (ICEs) (21, 33). Pneumococcal mobile elements (which are also found in other streptococci and Gram-positive cocci) can be loosely subdivided into two major groups of smaller (18-to 27-kb) and larger (Ͼ50-kb) elements (2, 23).The smaller genetic elements form the widespread Tn916 family, so called from the prototype, Tn916, an 18-kb transposon originally detected in Enterococcus faecalis when it was still regarded as a Streptococcus species (12). Tn916 family elements typically contain integrase (int 916 ) and excisionase (xis 916 ) genes and carry the tetracycline (TET) resistance determinant tet(M). These elements have been widely investigated, leading to the discovery of a variety of Tn916 ...