During the first 6 years after appearing in one hospital, a 92-kilobase conjugative plasmid, pBWHl, which encoded resistance to chloramphenicol and sulfonamides and determined TEM-1 beta-lactamase and 2"-aminoglycoside nucleotidyltransferase, underwent a variety of molecular changes. It was most prevalent initially in isolates of Klebsiella pneumoniae, then in isolates of Serratia marcescens, and finally, after nearly disappearing, in isolates of Enterobacter cloacae. Evolutionary changes in the plasmid did not account for its shifts in species distribution, since the original molecule was found in isolates of each species. The late resurgence of pBWHl occurred after a copy of its original molecule entered a distinctive ornithine decarboxylase-negative strain of E. cloacae, new to the hospital. The resulting transconjugant strain, chromosomally resistant to topical silver salts and to cephalosporins, and with the addition of pBWH1-encoded aminoglycoside resistance, spread in the hospital by causing an outbreak of sepsis in the burn unit, where these were commonly used antibacterial agents. Thus, an endemic plasmid became prevalent in a new host species because one of its genes supplemented the fitness of an uncommon strain of the species for a particular clinical niche.The percentages of clinical isolates of different bacterial species resistant to specific antibiotics are frequently calculated to delineate the usefulness of these drugs. Such tabulations will reflect in large part the distribution of resistance plasmids among strains of the species being surveyed, since a majority of resistance genes are carried by plasmids (4). The distribution of the plasmids may be determined by properties of the plasmids themselves such as their transferability, host range, or stability or the selective advantages conferred by their resistance genes or other cryptic genes (4,5). Also, properties of the host strains such as their fitness to occupy niches in which they come in contact with antibiotics might contribute to the observed distribution of plasmids.The surveillance of antibiotic resistance plasmids has been aided by plasmid fingerprinting, using restriction endonucleases (6,9,10,15,24,27)