From contaminant to catastrophe: Applying integrated antimicrobial stewardship DIA model in a case

In this editorial letter, we comment on the case report by Kataria et al , which describes Corynebacterium striatum infective endocarditis in a dialysis-dependent patient with advanced liver disease. We focus on the role of integrated antimicrobial stewardship (IAS) in distinguishing contamination from true infection, facilitating timely source control, and improving outcomes in complex healthcare-associated infections. Traditionally regarded as a contaminant or low-virulence commensal, Corynebacterium striatum is increasingly recognized as an opportunistic pathogen in vulnerable hosts with indwelling devices and prolonged healthcare exposure. The progression from repeated positive blood cultures to fatal multivalvular infective endocarditis highlights the challenges of differentiating contamination from true infection and underscores the importance of contextual microbiological interpretation. We emphasize that successful management of complex healthcare-associated infections requires more than appropriate antimicrobial therapy. IAS, as operationalized through the Society of Antimicrobial Stewardship PractIces 42-point framework, integrates diagnostic stewardship, microbiological stewardship, device stewardship, therapeutic optimization, infection prevention, surgical decision-making, educational initiatives, and administrative accountability. The case discussed illustrates how delays in diagnostic reassessment, source control, and multidisciplinary coordination can lead to adverse outcomes despite microbiologically appropriate treatment. Furthermore, it highlights the need for structured stewardship approaches such as the PRESCRIBES framework to strengthen interdepartmental collaboration and ensure timely, patient-centered interventions. Embedding IAS principles into routine clinical workflows, ‘DIA model’ , may improve outcomes in high-risk patients while simultaneously supporting antimicrobial resistance containment efforts.