A randomized clinical trial evaluated the effectiveness of rapid syndromic PCR testing in the emergency department (ED) for community-acquired pneumonia (CAP). The study involved 374 adults with suspected CAP, randomly assigned to either an intervention group receiving rapid PCR testing or a standard-of-care group. The intervention group received faster, more accurate microbiological test results, leading to pathogen-directed treatment in 35.3% of cases compared to 13.4% in the standard-of-care group. The median time to pathogen-directed treatment was reduced by 9.4 hours in the intervention group. The study found that molecular testing significantly increased the proportion of patients receiving targeted treatment and reduced the time to treatment. These findings suggest that routine use of PCR testing for lower respiratory tract pathogens could replace some standard, time-consuming diagnostics. The study highlights the potential of rapid molecular testing to improve diagnostic stewardship, reduce antibiotic overuse, and enhance patient outcomes. The results support the use of rapid syndromic PCR testing in the ED for CAP management. The study was conducted at Haukeland University Hospital in Bergen, Norway, and was approved by the Regional Committee for Medical and Health Research Ethics. The trial was stopped early due to significant differences in outcomes between the groups. The study found no significant differences in clinical outcomes between the intervention and standard-of-care groups. The results indicate that rapid molecular testing can improve the management of CAP by enabling faster, more targeted treatment. The study also found that the intervention group had a higher rate of appropriate antibiotic use and a lower rate of unnecessary broad-spectrum antibiotic use. The study concluded that routine deployment of PCR testing for lower respiratory tract pathogens could complement or replace selected standard, time-consuming laboratory-based diagnostics. The study was funded by the Research Council of Norway and the Trond Mohn Foundation. The findings suggest that rapid molecular testing could improve the diagnosis and management of CAP, leading to better patient outcomes and more efficient use of antibiotics.A randomized clinical trial evaluated the effectiveness of rapid syndromic PCR testing in the emergency department (ED) for community-acquired pneumonia (CAP). The study involved 374 adults with suspected CAP, randomly assigned to either an intervention group receiving rapid PCR testing or a standard-of-care group. The intervention group received faster, more accurate microbiological test results, leading to pathogen-directed treatment in 35.3% of cases compared to 13.4% in the standard-of-care group. The median time to pathogen-directed treatment was reduced by 9.4 hours in the intervention group. The study found that molecular testing significantly increased the proportion of patients receiving targeted treatment and reduced the time to treatment. These findings suggest that routine use of PCR testing for lower respiratory tract pathogens could replace some standard, time-consuming diagnostics. The study highlights the potential of rapid molecular testing to improve diagnostic stewardship, reduce antibiotic overuse, and enhance patient outcomes. The results support the use of rapid syndromic PCR testing in the ED for CAP management. The study was conducted at Haukeland University Hospital in Bergen, Norway, and was approved by the Regional Committee for Medical and Health Research Ethics. The trial was stopped early due to significant differences in outcomes between the groups. The study found no significant differences in clinical outcomes between the intervention and standard-of-care groups. The results indicate that rapid molecular testing can improve the management of CAP by enabling faster, more targeted treatment. The study also found that the intervention group had a higher rate of appropriate antibiotic use and a lower rate of unnecessary broad-spectrum antibiotic use. The study concluded that routine deployment of PCR testing for lower respiratory tract pathogens could complement or replace selected standard, time-consuming laboratory-based diagnostics. The study was funded by the Research Council of Norway and the Trond Mohn Foundation. The findings suggest that rapid molecular testing could improve the diagnosis and management of CAP, leading to better patient outcomes and more efficient use of antibiotics.