The role of DEdicated Infectious Disease consultant within an Antimicrobial Stewardship program towards a better patients' CARE (DE-IDCARE Project): results from a quasi-experimental, single-centre study

Alessandra Oliva; Cristiana Leanza; Lorenzo Martellone; Sara Covino; Cristiana Franchi; Francesca Cancelli; Martina Carnevalini; Virginia Corradini; Giuseppina Magni; Alessandro Coppola; Maria Augurusa; Giacomo Polito; Andrea Mingoli; Francesco Pugliese; Claudio Maria Mastroianni

doi:10.1016/j.jhin.2025.10.029

The role of DEdicated Infectious Disease consultant within an Antimicrobial Stewardship program towards a better patients' CARE (DE-IDCARE Project): results from a quasi-experimental, single-centre study

J Hosp Infect. 2025 Nov 8:S0195-6701(25)00350-0. doi: 10.1016/j.jhin.2025.10.029. Online ahead of print.

Authors

Affiliations

¹ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy; Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, AOU Policlinico Umberto I, Rome, Italy. Electronic address: alessandra.oliva@uniroma1.it.
² Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
³ Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, AOU Policlinico Umberto I, Rome, Italy.
⁴ Department of Anaesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy.
⁵ Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
⁶ University Hospital "Policlinico Umberto I", Rome, Italy.
⁷ Pharmacy Unit, AOU Policlinico Umberto I, Rome, Italy.
⁸ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy; Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, AOU Policlinico Umberto I, Rome, Italy.

PMID: 41213456
DOI: 10.1016/j.jhin.2025.10.029

Abstract

Background: The DE-IDCARE project aimed to evaluate the impact of dedicated Infectious Disease Consultations (CID) compared to traditional on-demand ID consultations (COD) within a structured Antimicrobial Stewardship Program (ASP).

Materials and methods: A quasi-experimental, single-centre study included hospitalized patients in two high-risk settings (Emergency Surgery-ES- and post NeuroSurgery Intensive Care Units- NS-ICU) receiving antimicrobial therapy during April-June 2023 (COD, PRE-Intervention, n=117) and April-June 2024 (CID, POST-Intervention, n=172). The CID model introduced tri-weekly systematic evaluations of all patients receiving antimicrobials. The intervention was assessed through 12 Antimicrobial Stewardship (AMS) indicators categorized into ID Stewardship (ID-S), Diagnostic Stewardship (D-S) and Therapeutic Stewardship (T-S) and classified into optimal, nearly optimal, neutral, suboptimal and not optimal according to the difference in percentage between CID and COD. Antimicrobial consumption was analysed using the AWaRe classification and the DDD/100 days of hospitalization. New onset of multi-drug resistant (MDR) colonization as well as clinical outcomes were also evaluated.

Results: CID led to significant improvements in the majority of AMS indicators, especially antimicrobial discontinuation in cases without infection (+46%), 48-72h re-evaluation of antimicrobial therapy (+36%) and duration of treatment (+21.1%). The use of Watch and Reserve antibiotics was reduced. New onset of MDR colonization was also reduced, while clinical outcomes were similar to COD.

Conclusion: The DE-IDCARE project underscores the potential of dedicated ID consultations within a structured ASP, leading to optimization of antimicrobial prescriptions without significantly affecting patients' outcomes. These findings offer a strong rationale for the wider implementation of CID as a cornerstone of effective AMS strategies.

Keywords: antimicrobial resistance; antimicrobial stewardship; consultation; infection control; infectious disease specialty.