{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:28:15Z","timestamp":1789698495436,"version":"4.0.1"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100017686","name":"Fujian Provincial Health Technology Project","doi-asserted-by":"publisher","award":["NO.2023QNA005"],"award-info":[{"award-number":["NO.2023QNA005"]}],"id":[{"id":"10.13039\/501100017686","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013795","name":"Fujian Medical University","doi-asserted-by":"publisher","award":["NO.2021QH1274"],"award-info":[{"award-number":["NO.2021QH1274"]}],"id":[{"id":"10.13039\/501100013795","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013795","name":"Fujian Medical University","doi-asserted-by":"publisher","award":["NO.2022QH1327"],"award-info":[{"award-number":["NO.2022QH1327"]}],"id":[{"id":"10.13039\/501100013795","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              Universal antepartum group B streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP) have effectively reduced early-onset GBS infections. However, GBS strains with chromosomal deletions affecting the\n              <jats:italic>cfb<\/jats:italic>\n              gene may produce false negatives in both the CAMP test and\n              <jats:italic>cfb<\/jats:italic>\n              -based molecular diagnostics, potentially increasing the risk of neonatal infections. Vaginal swabs were collected from pregnant women at 35\u201337 weeks of gestation in our hospital and cultured on agar. Suspected GBS strains were initially identified using the CAMP test and then confirmed with the VITEK-2 system. CAMP-negative GBS strains underwent additional testing by qPCR, 16S rDNA, serotyping, and multilocus sequence typing (MLST). PCR for the\n              <jats:italic>cfb<\/jats:italic>\n              gene and whole-genome sequencing were performed on CAMP-negative strains. From 5,794 samples, 526 (9.1%) GBS strains, including 19 (3.6%) CAMP-negative strains and 2 strains from the same patient, were isolated. All 19 CAMP-negative strains were serotypes III and ST862. Among these strains, only one strain was\n              <jats:italic>cfb<\/jats:italic>\n              positive by qPCR, whereas all tested positive with a multitarget qPCR kit for\n              <jats:italic>cfb<\/jats:italic>\n              and\n              <jats:italic>cps<\/jats:italic>\n              . PCR amplification upstream of the\n              <jats:italic>cfb<\/jats:italic>\n              gene produced a specific band in strain PP669713 only, suggesting N-terminal\n              <jats:italic>cfb<\/jats:italic>\n              gene retention in PP669713 and complete\n              <jats:italic>cfb<\/jats:italic>\n              loss in the other strains. Whole-genome sequencing confirmed a chromosomal deletion in PP669713. Antibiotic susceptibility testing revealed no resistance to penicillin. However, CAMP-positive strains presented a greater prevalence of resistance to ciprofloxacin, and levofloxacin than CAMP-negative strains did. Our study highlights the potential risk of missed GBS detection using CAMP tests and\n              <jats:italic>cfb<\/jats:italic>\n              -targeted molecular assays.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              Our work makes several novel contributions to the field. (i) We report the first documented case of a C-terminal deletion of the\n              <jats:italic>cfb<\/jats:italic>\n              gene in a CAMP-negative GBS strain, demonstrating that both N-terminal and C-terminal regions are essential for cohemolytic activity. (ii) Our findings reveal that CAMP-negative GBS strains (3.6% of isolates) are more prevalent than previously recognized, with most cases resulting from complete chromosomal deletions of the\n              <jats:italic>cfb<\/jats:italic>\n              gene. (iii) We provide evidence that single-target molecular assays targeting only the\n              <jats:italic>cfb<\/jats:italic>\n              gene may miss GBS detection, highlighting the necessity for multi-target approaches in clinical diagnostics. (iv) We demonstrate a unique antibiotic resistance pattern in CAMP-negative strains, showing significantly lower resistance to certain antibiotics compared to CAMP-positive strains.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.03257-24","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T13:01:01Z","timestamp":1744203661000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["CAMP-negative\n            <i>Streptococcus agalactiae<\/i>\n            strains exhibited complete or partial chromosomal deletions of the CAMP-factor encoding gene\n            <i>cfb<\/i>"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9265-2194","authenticated-orcid":true,"given":"Xixi","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meihong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haihua","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]},{"name":"Shengli Clinical Medical College, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Central Laboratory, Fujian Provincial Hospital, Center for Experimental Research in Clinical Medicine","place":["Fuzhou, China"]},{"name":"Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Key Laboratory of Cardiovascular Disease","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6935-149X","authenticated-orcid":false,"given":"Pengwei","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of 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