Panda PK, Khan F. From contaminant to catastrophe: Applying integrated antimicrobial stewardship DIA model in a case. World J Clin Cases 2026; 14(23): 123883 [DOI: 10.12998/wjcc.123883]
Corresponding Author of This Article
Prasan Kumar Panda, MD, Division of Internal Medicine, All India Institute of Medical Sciences, College Block, Rishikesh 249203, Uttarākhand, India. motherprasanna@rediffmail.com
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Infectious Diseases
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editorial
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Panda PK, Khan F. From contaminant to catastrophe: Applying integrated antimicrobial stewardship DIA model in a case. World J Clin Cases 2026; 14(23): 123883 [DOI: 10.12998/wjcc.123883]
World J Clin Cases. Aug 16, 2026; 14(23): 123883 Published online Aug 16, 2026. doi: 10.12998/wjcc.123883
From contaminant to catastrophe: Applying integrated antimicrobial stewardship DIA model in a case
Prasan Kumar Panda, Fatima Khan
Prasan Kumar Panda, Division of Internal Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India
Fatima Khan, Microbiology, Jawaharlal Nehru Medical Collge, Aligarh Muslim University, Aligarh 202006, Uttar Pradesh, India
Author contributions: Panda PK and Khan F searched the literature, drafted the manuscript statistically, critically reviewed it, and approved the study.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Prasan Kumar Panda, MD, Division of Internal Medicine, All India Institute of Medical Sciences, College Block, Rishikesh 249203, Uttarākhand, India. motherprasanna@rediffmail.com
Received: June 2, 2026 Revised: July 11, 2026 Accepted: July 27, 2026 Published online: August 16, 2026 Processing time: 73 Days and 7.9 Hours
Abstract
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.
Core Tip: Corynebacterium striatum, often dismissed as a contaminant, can cause severe and fatal infections in immunocompromised and device-dependent patients. This case demonstrates that adverse outcomes frequently result not from antimicrobial failure alone but from delayed integration of diagnostic, microbiological, device, therapeutic, and administrative stewardship measures. Integrated antimicrobial stewardship (IAS) provides a comprehensive framework for timely recognition, source control, multidisciplinary coordination, and optimized patient management. Implementing stewardship models, such as Society of Antimicrobial Stewardship PractIces’s 42 IAS practice points in form of DIA model and the PRESCRIBES framework, may improve clinical outcomes and reduce the burden of antimicrobial resistance in complex healthcare-associated infections.
