The dissemination of KPC carbapenemase-producing Pseudomonas aeruginosa is currently considered a public health problem. Although these enzymes are responsible of being part of the resistance to carbapenem, the genetic mechanisms that have favored the spread of KPC in this species are still unclear. Therefore, the objective of this research was to identify the mobile genetic elements (MGE) associated with the mobilization of blaKPC in P. aeruginosa, through a systematic review, to provide valuable information for the epidemiological knowledge of circulating strains worldwide.
The medical literature analysis and retrieval system online, were searched without language restrictions via PubMed and EMBASE on September 31, 2021. We select studies that included isolates of P. aeruginosa resistant to carbapenems and a description of the KPC mobilization platforms. Of the 132 potential articles, 42 were included after a screening based on inclusion/exclusion criteria. A descriptive analysis of the MGE was conducted to observe the dissemination factors of resistance to carbapenems.
The collected articles were reported on 12 countries located on America (n=42:62%), Asia (n=42:24%) and Europe (n=42:2%); from this information we identified 494 isolates of P. aeruginosa harboring blaKPC related with the different ST, such as: ST463 (n=494:22%), ST654 (n=494:13%), ST664 (n=494:4%) and ST235 (n=494:3%). Additionally, most isolates were associated with blaKPC-2, a largely reported variant.
We also analyzed the general location of this resistance gene (Plasmids (n=494:46%), chromosome (n=494:1%), non-specified (n=494:52,8%)) and its surroundings, revealing that the most common genetic environment is the Tn4401 (n=494:17%), followed by a diversity of non-Tn4401 elements (n=494:11%).
This constitutes the first review about the genetic panorama of KPC dissemination in P. aeruginosa strains by MGE, and suggest that the plasmids and some transposable elements, are responsible for the epidemiological success worldwide; also, the different reported STs reveal alarming dynamic of the increase in carbapenem resistant P. aeruginosa clones.
