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We describe four cases of a novel carbapenem-resistant Pseudomonas aeruginosa ST179 clone carrying the bla KPC-2 or bla , imported from Peru to Spain and isolated from leukemia patients. All isolates were multidrug-resistant but remained susceptible to fosfomycin, cefiderocol, and colistin. Whole-genome sequencing revealed that KPC-35 gene together with bla IMP-16 , imported from Peru to Spain and isolated from leukemia patients. All isolates were multidrug-resistant but remained susceptible to fosfomycin, cefiderocol, and colistin. Whole-genome sequencing revealed that bla KPC-2 and bla KPC-35 were located in an IncP6 plasmid, whereas bla IMP-16 was in a chromosomal type 1 integron. This study highlights the global threat of multidrug-resistant P. aeruginosa clones and underscores the importance of monitoring and early detection of emerging resistance mechanisms to guide appropriate treatment strategies. The importation and spread of such clones emphasize the urgent need to implement strict infection control measures to prevent the dissemination of carbapenem-resistant bacteria., Importance: This is the first documented case of a Pseudomonas aeruginosa ST179 strain carrying the blaKPC-35 gene, and it represents the first report of a P. aeruginosa co-harboring blaIMP-16 and either blaKPC-2 or blaKPC-35, which wre imported from Peru to Spain, highlighting a threat due to the capacity of spreading carbapenem-resistance via plasmid conjugation., Competing Interests: A.S. has received honoraria for lectures and advisory boards from Pfizer, MSD, Angelini, Shionogi, Menarini, and Gilead. C.G.-V. has received honoraria for talks on behalf of MSD, Pfizer, and Shianogi as well as a grant from Gilead Science and GSK. more...