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Background  CTX-M-producing  Escherichia coli  strains are regarded as major global pathogens.    Methodology/Principal Findings  The nucleotide sequence of three plasmids (pEC_B24: 73801-bp; pEC_L8: 118525-bp and pEC_L46: 144871-bp) from  Escherichia coli  isolates obtained from patients with urinary tract infections and one plasmid (pEC_Bactec: 92970-bp) from an  Escherichia coli  strain isolated from the joint of a horse with arthritis were determined. Plasmid pEC_Bactec belongs to the IncI1 group and carries two resistance genes:  bla   TEM-1  and  bla   CTX-M-15 . It shares more than 90% homology with a previously published  bla   CTX-M -plasmid from  E. coli  of human origin. Plasmid pEC_B24 belongs to the IncFII group whereas plasmids pEC_L8 and pEC_L46 represent a fusion of two replicons of type FII and FIA. On the pEC_B24 backbone, two resistance genes,  bla   TEM-1  and  bla   CTX-M-15 , were found. Six resistance genes,  bla   TEM-1 ,  bla   CTX-M-15 ,  bla   OXA-1 ,  aac6'-lb-cr ,  tetA  and  catB4 , were detected on the pEC_L8 backbone. The same antimicrobial drug resistance genes, with the exception of  tetA , were also identified on the pEC_L46 backbone. Genome analysis of all 4 plasmids studied provides evidence of a seemingly frequent transposition event of the  bla   CTX-M-15 -IS Ecp1  element. This element seems to have a preferred insertion site at the  tnpA  gene of a  bla   TEM -carrying Tn 3 -like transposon, the latter itself being inserted by a transposition event. The IS 26 -composite transposon, which contains the  bla   OXA-1 ,  aac6'-lb-cr  and  catB4  genes, was inserted into plasmids pEC_L8 and pEC_L46 by homologous recombination rather than a transposition event. Results obtained for pEC_L46 indicated that IS 26  also plays an important role in structural rearrangements of the plasmid backbone and seems to facilitate the mobilisation of fragments from other plasmids.    Conclusions  Collectively, these data suggests that IS 26  together with IS Ecp1  could play a critical role in the evolution of diverse multiresistant plasmids found in clinical  Enterobacteriaceae .

Complete Nucleotide Sequence of CTX-M-15-Plasmids from Clinical Escherichia coli Isolates: Insertional Events of Transposons and Insertion Sequences