Clinical and Microbiological Study of Fungi as an Aetiological Agent in Patients of Ventilator Associated Pneumonia in Intensive Care Unit of a Tertiary Care Hospital

Abstract

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.