Worldwide Dissemination of bla(KPC) Gene by Novel Mobilization Platforms in Pseudomonas aeruginosa: A Systematic Review

The dissemination of bla(KPC)-harboring Pseudomonas aeruginosa (KPC-Pa) is considered a serious public health problem. This study provides an overview of the epidemiology of these isolates to try to elucidate novel mobilization platforms that could contribute to their worldwide spread. A systematic review in PubMed and EMBASE was performed to find articles published up to June 2022. In addition, a search algorithm using NCBI databases was developed to identify sequences that contain possible mobilization platforms. After that, the sequences were filtered and pair-aligned to describe the bla(KPC) genetic environment. We found 691 KPC-Pa isolates belonging to 41 different sequence types and recovered from 14 countries. Although the bla(KPC) gene is still mobilized by the transposon Tn4401, the non-Tn4401 elements (NTE(KPC)) were the most frequent. Our analysis allowed us to identify 25 different NTE(KPC), mainly belonging to the NTE(KPC)-I, and a new type (proposed as IVa) was also observed. This is the first systematic review that consolidates information about the behavior of the bla(KPC) acquisition in P. aeruginosa and the genetic platforms implied in its successful worldwide spread. Our results show high NTE(KPC) prevalence in P. aeruginosa and an accelerated dynamic of unrelated clones. All information collected in this review was used to build an interactive online map.