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.