A Race against Time: Rapid Molecular Diagnostics vs Standard Culture for Hospital-acquired Pneumonia in Intensive Care Unit

Background: In the intensive care unit (ICU), reliance on conventional culture techniques for diagnosing hospital-acquired pneumonia (HAP) is associated with delayed pathogen identification, frequently resulting in extended use of broad-spectrum antibiotics and suboptimal clinical outcomes.Although rapid molecular diagnostic tools have the potential to enhance early therapeutic decisions, evidence from randomized studies evaluating their impact on patient-centered outcomes remains limited. Materials and methods:We performed a single-center, randomized controlled trial in an adult anesthesia ICU, enrolling 60 patients who developed clinical suspicion of HAP more than 48 hours after hospital admission.Participants were randomized in a 1:1 ratio to either conventional microbiological diagnosis using semiquantitative streak culture (control group, n = 30) or rapid pathogen detection using a multiplex molecular assay [BioFire FilmArray Pneumonia Panel (BFPP); intervention group, n = 30].The primary endpoints were 30-day all-cause mortality and duration of ICU stay.Secondary endpoints included total duration of antimicrobial therapy, longitudinal changes in sequential organ failure assessment (SOFA) and APACHE-II scores, and overall treatment costs.Results: All enrolled patients completed the trial, and baseline demographic and clinical variables were comparable between the two groups.The intervention arm demonstrated a significantly lower 30-day mortality compared with the control arm (20.0 vs 46.7%; p = 0.028).Intensive care unit stay was also significantly shorter in the intervention group, with a median reduction of 3.7 days (9.27 vs 13.00 days; p = 0.001).In addition, patients managed with rapid molecular diagnostics showed faster improvement in SOFA and APACHE-II scores (p < 0.001 for trend), required a shorter course of antibiotic therapy (median 9.27 vs 13.00 days; p = 0.001), and incurred significantly lower mean total treatment costs (₹41,066 vs ₹69,207; p < 0.001).Conclusion: Among critically ill patients with suspected HAP, the use of a rapid multiplex molecular diagnostic approach was associated with significant reductions in 30-day mortality, ICU length of stay, antibiotic exposure, and overall treatment costs when compared to conventional culture-based diagnostic strategies.