Clostridium ramosum Bacteremia in an Immunocompetent Patient with SARS-CoV-2 Infection: A Case Report

Danni Bao,1 Xiaohong Xu,1 Yizhang Wang,1 Fengjiao Zhu,1 Yanhong Wu,1 Hongzhang Li2 1Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China; 2Department of Gastroenterology, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of ChinaCorrespondence: Hongzhang Li, Department of Gastroenterology, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China, Email lihongzhang@zjsmyy.comAbstract: We report a case of Clostridium ramosum bacteremia in a 73-year-old patient with SARS-CoV-2 infection and right lower abdominal tenderness in China. The microbiological features and genomic epidemiological characteristics of C. ramosum worldwide were investigated to identify the possible sources of infection. Whole-genome sequencing of C. ramosum WD-I2 was performed using an Illumina NovaSeq 6000 platform. Phylogenetic analysis of C. ramosum WD-I2 and other publicly available C. ramosum isolates was performed and visualized using the interactive Tree of Life (iTOL) web server. The resistome of C. ramosum WD-I2 consists of two antimicrobial resistance genes (tetM and ermB), which explains the antimicrobial resistance trait to tetracycline and macrolides. Phylogenetic analysis showed that the strain closest to our isolated strain WD-I2 was SUG1069, recovered from a pig feces sample from Canada, which differed by 589 SNPs. To our knowledge, this is the first report of C. ramosum bacteremia in China. Our findings highlight the potential risk of invasive C. ramosum infections during the COVID-19 pandemic.Keywords: Clostridium ramosum, bacteremia, antimicrobial resistance, SARS-CoV-2, whole genome sequencing