Candida Spp. in the respiratory tract : a real causality with worse outcomes or just a marker of severity?

• Candida spp. is the most common cause of intensive care unit (ICU) invasive fungal infections worldwide. • The isolation of Candida spp. from respiratory tract secretions of non-immunocompromised, mechanically ventilated patients varies between 20% and 55%, but it might represent colonisation rather than infection. • Candida spp. colonisation promotes bacterial pneumonia in animal models. • Candida spp. colonisation could clinically increase the risk for Pseudomonas aeruginosa ventilator-associated pneumonia, prolong mechanical ventilation and stay and worsen outcomes, but to date contrasting data are available. • Available evidence is not sufficient to support routine antifungal therapy in non-immunocompromised patients.