Candida albicans is an opportunistic pathogen frequently found in the normal microflora of the human body. Recovery of Candida from the respiratory tract of a critically ill patient receiving mechanical ventilation (MV) without risk factors for immu-nodepression is common. Clinical studies, into the clinical relevance of “positive” unprotected or protected, proximal or distal, specimens from ICU patients after > 2 days of MV have shown a poor correlation between Candida-positive respiratory samples (colonization) and invasive pulmonary candidiasis. In most patients, lung biopsy or lung autopsy specimens showed tracheobronchial colonization without evidence of invasive pulmonary candidiasis despite respiratory specimen Candida counts above the thresholds used to define bacterial nosocomial pneumonia. In one study,2, alveolitis was found in several patients, but there was no evidence of a causal relation with Candida, since other organisms were usually present also, Bronchial Candida colonization did not lead to excess mortality but resulted in longer ICU and hospital stay durations, as well as in higher management costs. However, it has been suggested that bronchial Candida colonization in patients receiving MV should be interpreted in the light of the colonization index, as colonization of multiple body sites is a risk factor for systemic candidiasis. read
Studies have found evidence of interactions between Candida and Pseudomonas, with Candida colonization possibly increasing the risk for Pseudomonas infection. In the European Prevalence of Infection in Intensive Care study, Vin-cent determined the prevalence of ICU-acquired infections and identified the predominant organisms. Pseudomonas aeruginosa and Candida species were among the most prevalent organisms (28.7% and 17.1%, respectively). Similarly, Candida and Pseudomonas were among the most common pathogens retrieved from endotracheal tube biofilm and tracheal secretions in patients with ventilator-associated pneumonia (VAP). Moreover, El-Azizi et al reported that C albicans biofilms could hold other organisms, including P aeruginosa, within the endotracheal tube.