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Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are a significant cause of morbidity and mortality among patients in the intensive care unit (ICU). Early antibiotic therapy improves patient outcomes, but delays in pathogen identification results in suboptimal antimicrobial stewardship. Rapid molecular diagnostics can identify pathogens with increased speed and sensitivity, but evidence demonstrating clinical benefit has been limited. Enne et al (Intensive Care Med 2025;51:272) conducted the INHALE WP3 trial, a randomised, multicenter trial assessing the clinical utility of rapid PCR test compared with standard of care. Among 554 patients hospitalised for HAP or VAP across 14 ICUs in the United Kingdom, 277 patients were each randomised to the rapid PCR group and standard of care. Rapid PCR substantially improved the time for pathogen identification, with results available in under 2 hours compared with approximately 74 hours for routine cultures. In the intention-to-treat analysis, 76.5% of patients in the intervention group and 55.9% of patients in the control group received appropriate and proportionate antibiotics within 24 hours (estimated difference 21%, 95% CI 13 to 28%). However, improved stewardship did not translate into clinical benefit, as rapid PCR failed to establish noninferiority for the clinical cure of pneumonia at 14 days (56.7% in intervention group compared with 64.5% in the control group). The INHALE W3 trial underscores both the potential and limitations of rapid molecular diagnostics. While rapid PCR can improve antibiotic stewardship, further research is needed to better understand how to translate diagnostic information into safe and effective clinical care.