{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:38:10Z","timestamp":1793813890515,"version":"4.6.1"},"reference-count":43,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2002,11,1]],"date-time":"2002-11-01T00:00:00Z","timestamp":1036108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2002,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            <jats:italic>Citrobacter<\/jats:italic>\n            spp. are gram-negative commensal bacteria that infrequently cause serious nosocomial infections in compromised hosts. They are often resistant to cephalosporins due to overexpression of their chromosomal \u03b2-lactamase. During a recent study of multidrug-resistant\n            <jats:italic>Enterobacteriaceae<\/jats:italic>\n            (MDRE) in solid-organ transplant patients, we found that almost half of patients colonized with MDRE carried one or more cefpodoxime-resistant\n            <jats:italic>Citrobacter freundii<\/jats:italic>\n            ,\n            <jats:italic>Citrobacter braakii<\/jats:italic>\n            , or\n            <jats:italic>Citrobacter amalonaticus<\/jats:italic>\n            strains. Pulsed-field gel electrophoresis showed that 36 unique strains of\n            <jats:italic>Citrobacter<\/jats:italic>\n            were present among 32 patients. Genetic and phenotypic analysis of the resistance mechanisms of these bacteria showed that the extended-spectrum \u03b2-lactamase (ESBL) SHV-5 or SHV-12 was encoded by 8 strains (26%) and expressed by 7 strains (19%). A number of strains were resistant to other drug classes, including aminoglycosides (28%), trimethoprim-sulfamethoxazole (31%), and fluoroquinolones (8%). PCR and DNA analysis of these multiresistant strains revealed the presence of class I integrons, including the first integrons reported for\n            <jats:italic>C. braakii<\/jats:italic>\n            and\n            <jats:italic>C. amalonaticus<\/jats:italic>\n            . The integrons encoded aminoglycoside resistance, trimethoprim resistance, or both. Despite the prevalence of MDR\n            <jats:italic>Citrobacter<\/jats:italic>\n            spp. in our solid-organ transplant patients, only a single infection with a colonizing strain was recorded over 18 months. Low-virulence\n            <jats:italic>Citrobacter<\/jats:italic>\n            spp., which can persist in the host for long periods, could influence pathogen evolution by accumulation of genes encoding resistance to multiple antimicrobial classes.\n          <\/jats:p>","DOI":"10.1128\/aac.46.11.3555-3560.2002","type":"journal-article","created":{"date-parts":[[2002,10,16]],"date-time":"2002-10-16T23:01:16Z","timestamp":1034809276000},"page":"3555-3560","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":86,"title":["Low-Virulence\n            <i>Citrobacter<\/i>\n            Species Encode Resistance to Multiple Antimicrobials"],"prefix":"10.1128","volume":"46","author":[{"given":"C.","family":"Pepperell","sequence":"first","affiliation":[{"name":"The Centre for Infection and Biomaterials Research, Hospital for Sick Children Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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