Bridging the Gap Between Strategy and Implementation in Antimicrobial Stewardship: Insights from the ARCO Step II...

National and international frameworks provide strategic direction for antimicrobial stewardship (AMS), while their translation into operational practice remains inconsistent. Building on ARCO Step I findings, this study aimed to establish an interregional, multidisciplinary consensus on sustainable AMS implementation strategies across hospital and community settings in Northeastern Italy. A modified Delphi methodology engaged 33 interdisciplinary professionals from Northeastern Italy. Eighteen operational statements across three domains (Governance, Hospital AMS, Community AMS) underwent two quantitative scoring rounds (relevance and feasibility; 1-10 scale) separated by a structured in-person workshop with thematic round-table discussions. Consensus threshold was defined as median score ≥ 8.0; high-priority statements required combined score ≥ 8.5. All 18 statements achieved consensus for relevance, whereas 12 statements achieved consensus for feasibility. Post-discussion median scores feasibility showed a numerically larger increase for feasibility (Δ +0.78) compared to relevance (Δ +0.44), indicating that structured deliberation reduced perceived implementation barriers. Furthermore, 14 statements were classified as high-priority. Qualitative analysis identified key enablers (CEO performance mandates, multidisciplinary teams, standardized indicators) and barriers (digital infrastructure gaps, resource constraints). The participatory approach helped translate strategic policy into a set of practice-oriented recommendations, offering a potentially transferable model for regional health authorities implementing AMR action plans, pending evaluation of actual implementation.