An unexpected pathogen: Gardnerella vaginalis ventilator-associated pneumonia in severe burn patients.

Gardnerella vaginalis is a commensal component of the vaginal microbiota, only rarely implicated in ventilator-associated pneumonia (VAP). We describe two cases of G. vaginalis pneumonia in severely burned patients admitted to a burn intensive care unit. Both developed symptomatic VAP, and G. vaginalis was isolated from bronchoalveolar lavage specimens at significant quantitative thresholds, suggesting a pathogenic role. Antimicrobial therapy led to clinical improvement and microbiological clearance in both cases. A literature review identified eight previously reported cases of G. vaginalis pneumonia, but none involving burn patients. The combination of immune dysfunction, mucosal barrier disruption, and prior broad-spectrum antibiotic exposure may have facilitated pulmonary colonization or infection. These observations highlight the potential of G. vaginalis to act as an opportunistic respiratory pathogen in critically ill patients and emphasize the importance of accurate microbial identification and targeted antibiotic selection when atypical organisms are encountered in respiratory specimens.