Introduction: In Intensive Care Units (ICUs), Ventilator Associated Pneumonia (VAP) is the commonest nosocomial infection. Fungal infections especially Candida spp. have emerged as one of the commonest organisms in causing VAP. It increases morbidity and mortality to a great extent in critically ill patients, with risk factors like old age, co-morbidities like diabetes, Chronic Obstructive Pulmonary Disease (COPD), infectious or multisystem disease. Hence, it becomes necessary to isolate and speciate the fungi along with its Antifungal Susceptibility Testing (AFST) for early diagnosis and treatment. This is done by microbiological investigation where in samples (bronchoscopic/ nonbronchoscopic) are obtained from the lower respiratory tract. Aim: To study the fungal profile among clinically and radiologically diagnosed VAP cases. Materials and Methods: This was a prospective study carried out in the Department of Microbiology, Dr Vaishampayan Memorial Govt Medical College, Solapur, Maharashtra, India, in which 120 clinically and radiologically diagnosed VAP patients were included. Endotracheal Aspirate (ETA) of these patients was collected aseptically. The sample was then subjected to Gram stain, Lacto Phenol Cotton Blue (LPCB), culture on Sabouraud’s Dextrose Agar (SDA) and Chromogenic (CHROM) agar and AFST was performed by broth dilution technique. The data was statistically analysed. Results: In this study, out of 120 patients, 52 patients were diagnosed as VAP on day 5. Late onset pneumonia was more common in 61.67%. Non-infective cases were 49.17% and infective cases were 28.33%. Patients belonged to different age groups with maximum between 31-40 years. Out of 120 cases of VAP, yeast was isolated from 26 cases. Most common pathogenic yeast isolated was Candida albicans (53.85%). All yeast isolates were susceptible to fluconazole and amphotericin B except one isolate of Candida krusei, Candida tropicalis and Candida glabrata each were resistant to both fluconazole and amphotericin B. Conclusion: Candida albicans was the commonest yeast isolated. Resistance was noted among the non-albicans spp of Candida. The non-albicans Candida is growing as an emerging threat. Early diagnosis and AFST will help in reducing the morbidity and mortality.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Two cases of Rhinocladiella mackenziei have been noted in our institute, the first case in 2015 (post-renal transplant) and the second case in 2021 (post-COVID infection). Both the patients had received immunosuppressants for varying duration. Both the cases presented to the hospital with neurological deficit secondary to brain abscess. On initial assessment, the melanized fungus was noted which was later identified as Rhinocladiella on culture and further confirmed with molecular methods. Both the cases were treated with injection of L AmB, voriconazole and 5FC for a prolonged duration and later discharged when the condition improved. The renal transplant patient was advised lifelong voriconazole since he would continue to be on immunosuppressants. To our knowledge, the second patient diagnosed post-COVID could be the first case report of invasive dematiaceous fungal infection in an apparently immunocompetent individual. Both cases also highlight the challenges in management such as designing an appropriate regimen, deciding the optimum duration of antifungal therapy, and managing the toxicities associated with long-term antifungal use. R. mackenziei is a frequently fatal melanized neurotropic fungus known to carry almost 100% mortality despite the combination of antifungal agents and surgery. Central nervous system infections due to R. mackenziei have been exclusively reported from the Middle East, except for cases recently reported from India.

The authors report a case of a 64-year-old diabetic male patient with late-onset fulminant fungal endophthalmitis occurring 6 weeks following complicated cataract surgery. A pigmented, dimorphic fungus known as Exophiala dermatitidis was isolated from aqueous and vitreous samples of the patient. The patient underwent pars plana vitrectomy, followed by daily injections of intravitreal voriconazole, and eventually had marked improvement in the best-corrected visual acuity to 6/9. So far, eight cases of Exophiala endophthalmitis have been reported in the literature, of which six have had a poor visual outcome. This case report demonstrates a successful outcome in a case of E. dermatitidis endophthalmitis, tackled with an aggressive medical and surgical approach.