Bridging the Gap Between Strategy and Implementation in Antimicrobial Stewardship: Insights from the ARCO Step II Interregional Delphi Consensus in Northeastern Italy.

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.