Candida pneumonia is not usually a pathogen of ventilator-associated pneumonia (VAP). However, Candida pneumonia may occur. A diagnosis is difficult, if not impossible, to make in critically ill patients. Regular indications for treatment are restricted to histological proof or systemic infection. Because of the potential for Candida aspiration pneumonia and Candida colonisation, possibly favouring VAP and tracheobronchial colonisation with Pseudomonas aeruginosa, patients with oral and/or oesophageal candidiasis should receive specific treatment.
Although uncommon, Aspergillus spp. pneumonia is a potential threat for critically ill patients. Patients with chronic obstructive pulmonary disease, advanced liver cirrhosis, solid organ cancer and, in particular, steroid use, should be recognised to be at a moderately increased risk for pulmonary aspergillosis. The diagnosis of pulmonary aspergillosis is based on histology or, if this is not available, a three-category approach including host factors and clinical and microbiological criteria. Patients with proven or probable pulmonary aspergillosis should be treated early and effectively. According to current guidelines, voriconazole is the treatment of choice. Alternatively, liposomal amphotericin B or echinocandins can be used.