AETIOLOGY OF VENTILATOR-ASSOCIATED PNEUMONIA (VAP) IN PATIENTS HAVING CANDIDA COLONIZATION IN ENDOTRACHEAL ASPIRATE

Background and Aims: Ventilator-associated pneumonia (VAP) is a severe complication in intensive care unit (ICU) patients requiring prolonged mechanical ventilation. While traditionally associated with bacterial pathogens, fungal colonization, particularly by Candida species, has emerged as an area of interest. This study investigates the aetiology of VAP in patients with Candida colonization detected in endotracheal aspirates. The aim is to assess the prevalence of Candida spp., their role in VAP pathogenesis, and whether they necessitate specific therapeutic interventions or act as predictive markers for bacterial VAP. Methods: This prospective observational study was conducted in the ICU of Heritage Institute of Medical Sciences, Varanasi, after ethical clearance (HIMS/IEC/127/2022). Patients aged 18 years or older on mechanical ventilation for over 48 hours were included, while those on antifungal treatment, pregnant women, and those with positive cultures at intubation were excluded. Endotracheal aspirates were analyzed for fungal and bacterial cultures using the VITEK®2 system. Data were processed using SPSS version 25, with results expressed as mean ± SD, median, and 95% confidence intervals. A p-value < 0.05 was considered statistically significant. Results: The mean age of participants was 48.28 ± 22.41 years, with males constituting 61.25%. Candida albicans was the most prevalent fungal isolate (63.3%), followed by Candida tropicalis. Pseudomonas aeruginosa (21.57%) and Klebsiella pneumoniae (9.16%) were the leading bacterial pathogens. VAP culture positivity was observed in 34.17% of cases, with significant associations between Candida colonization and prolonged ventilation. Conclusion: Candida spp., particularly Candida albicans, play a critical role in VAP pathogenesis, often co-existing with bacterial pathogens like Pseudomonas aeruginosa. These findings highlight the need for enhanced diagnostic strategies and tailored therapeutic protocols targeting fungal and bacterial co-pathogens.