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Background: In 1997 an infectious disease service (IDS) similar to those in the US was established at a university hospital in Munich, Germany. Patients and Methods: We assessed the economic impact of the new policy by performing a cost comparison analysis. Inpatients with pneumonia, skin infections/cellulitis, urinary tract infections (UTI) and bacteremia/sepsis were assigned to two groups: patients from a 6-month period after the establishment of the IDS (post-IDS group) were compared with similar patients before the implementation of the ID-servide (pre-IDS group). Costs of microbiological investigation (MB), antibiotic treatment (AB), clinical imaging (CI), total costs and length of antibiotic therapy were analyzed. Results: Patients with UTIs in the post IDS-group had 39% fewer MBs (p < 0.05) than patients in the pre-IDS group, resulting in a 33% decrease in average MB costs (p < 0.05). In the total group, in which subgroups with pneumonia, skin infection and UTI were summarized, the post-IDS group had 37% fewer MBs (p < 0.05) resulting in MB cost reductions of 34% (p < 0.05). There were no significant differences in expenditures for AB and CI and in the average length of antibiotic therapy. Conclusion: This study shows that continuous consultation by an IDS does not increase diagnostic and treatment costs, but results in significant cost reductions.