We characterized two new gene cassettes in an Acinetobacter isolate: one harbored the metallo--lactamase (IMP-4) gene bla IMP-4 , the other harbored the rifampin ADP-ribosyltransferase (ARR-2) gene arr-2, and both arrayed with the aminoglycoside acetyltransferase [AAC(6)-Ib 7 ] gene cassette aacA4 in two separate class 1 integrons. The epidemiology of these gene cassettes in isolates from blood cultures obtained from 1997 to 2000 was studied. Isolates bearing either the bla IMP-4 or the arr-2 gene cassette or both represented 17.5% (10 of 57) of isolates in 1997, 16.1% (10 of 62) in 1998, 2.5% (1 of 40) in 1999, and 0% (0 of 58) in 2000. These two gene cassettes, probably borne on two separate integrons, were found in at least three genomic DNA groups, with evidence of clonal dissemination in the intensive care unit during 1997 to 1998. Seventeen of the 52 Acinetobacter baumannii (genomic DNA group 2) isolates from 1997 to 2000 harbored intI1, but only one was positive for these gene cassettes, whereas 20 of the 21 intI1-positive isolates of all other genomic DNA groups were positive for either or both of them. Reduced susceptibility to imipenem and rifampin was seen only in isolates harboring the bla IMP-4 and arr-2 cassettes, respectively. The aminoglycoside phosphotransferase [APH(3)-VIa] gene aph(3)-VIa was detected in all 21 isolates for which the MIC of amikacin was >8 g/ml, with or without aacA4, whereas aacA4 alone was found in isolates for which the MIC of amikacin was 0.5 to 2 g/ml. Significant differences between the 17 intI1-positive and 47 intI1-negative isolates belonging to genomic DNA group 3 from 1997 to 1998 in the MICs of amikacin, gentamicin, imipenem, sulfamethoxazole, and ceftazidime were observed (Mann-Whitney test, P < 0.001 to 0.01).In the past decade, there has been an explosion of interest in the integron, a genetic element which facilitates gene dissemination among bacteria of different species and perhaps genera, thus establishing the possibility of a wide dispersal of antimicrobial resistance. These genetic elements are marked by the presence of two conserved regions between which gene cassettes are integrated at a recombination site known as attI. The 5Ј-conserved region of an integron contains an integrase gene, intI, and a promoter (P c ) which drives the expression of any integrated gene cassettes. Individual gene cassettes, existing in a free circularized form when not integrated, are comprised of an open reading frame (ORF) and a 59-base element (59-be) at the 3Ј end. The 59-be is a family of recombination sites that act as substrates to integrase-mediated recombination (43). To date, over 70 resistance cassettes have been described (32, 45). According to the 3Ј-conserved sequence (3Ј-CS), integrons are divided into three classes. The majority of the resistance cassette-bearing integrons belong to class 1, and these carry, at the 3Ј-CS, the truncated quaternary ammonium compound resistance gene qacE⌬1, the sul1 sulfonamide resistance gene, and orf5, of unknown function (20).A...