antibiogram-sum-2017
antibiogram-sum-2017
Released:
October 2018
The New Hampshire Department of Health and Human Services, Division of Public Health Services (DPHS),
Healthcare Associated Infections (HAI) Program has released the 2017 statewide antibiograms for non-urine and urine
clinical isolates. Included is one presentation of the data showing the percent susceptibility, and a second presentation
which shows the total number of isolates in the numerator and denominator that corresponds to each percent
susceptible value. Methodology and data limitations can be found in the Appendix at the end of the document.
Purpose
The information contained in these antibiograms can help clinicians choose appropriate empiric antibiotics to
treat common infectious syndromes and avoid overuse of broad spectrum antibiotics. Antibiotics should be
chosen based on the clinical syndrome and the most likely pathogen(s) associated with the clinical syndrome.
Annual antibiogram analysis allows the New Hampshire DPHS to evaluate temporal trends and geographic
patterns of antibiotic resistance to guide antibiotic stewardship efforts at the local, regional, and state level.
Antibiotic stewardship refers to the implementation of coordinated efforts to promote the appropriate use of
antibiotics in order to improve patient outcomes, reduce antibiotic resistance, and prevent the spread of
multidrug-resistant organisms.
Clinical Implications
This year’s Executive Summary expands on the 2016 State Antibiogram and Executive Summary guidance (released in
2017) and focuses on improving treatment of urinary tract infections (UTIs), pneumonia, and skin and soft tissue
infections. Each patient should be treated based on a clinician’s assessment of the type of infection and acuity, and a
patient’s antibiotic regimen should always be tailored to susceptibility testing results once they are available.
• “High” resistance to an antibiotic is when more than 20% of isolates are resistant
• The following antibiotics indicate susceptibility to others in the same/related class
o Oxacillin predicts nafcillin susceptibility
o Tetracycline predicts doxycycline susceptibility
o Erythromycin predicts azithromycin susceptibility
o Ampicillin predicts amoxicillin susceptibility
o Cefazolin predicts cephalexin susceptibility
o Ampicillin/sulbactam predicts amoxicillin/clavulanate susceptibility
• In most patients, asymptomatic bacteriuria should not be treated with antibiotics. Treatment may be
indicated during pregnancy, before certain urologic procedures, and in first three months after renal
transplant.
• The most common Gram-negative bacteria to be isolated from urine were Escherichia coli (70% of isolates)
followed by Klebsiella spp. (14%) and Proteus mirabilis (5%). Pseudomonas aeruginosa was recovered in
fewer than 5% of urine specimen cultures; therefore, empiric UTI coverage with a fluoroquinolone to cover
Pseudomonas is not usually needed.
• Nitrofurantoin remains the most likely active agent against Escherichia coli (98% susceptible), followed by
cephalexin (predicted by cefazolin, 92% susceptible). Trimethoprim-sulfamethoxazole and ciprofloxacin are
less likely to be active, and we recommend avoiding ciprofloxacin as first-line therapy because of the
potential for toxicity and C. difficile infection.
• We recognize that many providers are prescribing antibiotic therapy for UTIs by phone. We recommend that
providers obtain a urine culture before antibiotics are started in cases where the provider elects initial broad
spectrum antibiotic therapy (e.g., third-generation cephalosporin or fluoroquinolone), or when a patient has
failed the above recommended narrow spectrum therapy.
• Most SSTIs are due to either streptococcal infection or Staphylococcus aureus. Non-purulent SSTIs (e.g.
cellulitis) are usually not caused by methicillin-resistant Staphylococcus aureus (MRSA), so coverage of this
organism is not necessary. 68% all non-urine Staphylococcus aureus isolates in New Hampshire were
methicillin-sensitive Staphylococcus aureus (MSSA). There are many options that treat both streptococci and
MSSA, including ceftriaxone, cefazolin, cephalexin, and dicloxacillin.
• Two studies have now demonstrated no benefit in adding an empiric MRSA antibiotic to the more standard
therapy targeted at streptococci and MSSA in cases of non-purulent SSTIs (Clin Infect Dis 2013;56:1754-62
and JAMA 2017;317:2088-96).
• In the case of skin abscess (i.e. purulent SSTI), the abscess should be incised and drained with drainage sent
for bacterial Gram-stain and culture. Empiric outpatient therapy with either trimethoprim-sulfamethoxazole
or doxycycline (97% and 94% susceptibility against MRSA, respectively) are the preferred antibiotic regimens
for MRSA SSTIs. Adjunctive antibiotic therapy does improve cure rates when paired with incision and
drainage (N Engl J Med 2016;374:823-32 and N Engl J Med 2017;376:2545-5).
• Over 90% of patients with a penicillin allergy listed in their medical record are not actually allergic to
penicillin, and over 80% of penicillin allergic patients "outgrow" their allergy after 10 years. Additionally, in
patients with a confirmed penicillin allergy, less than 2% have a reaction to cephalosporins. Therefore,
patients with any history of a penicillin allergy should be evaluated by taking a thorough history of their
allergy, and providers should consider: 1) de-labeling the penicillin allergy, 2) providing a supervised
penicillin challenge (if patient reports a mild reaction), or 3) penicillin skin testing (for moderate or serve
reactions). In a setting without access to penicillin skin testing, patients with mild penicillin allergy, such as
morbilliform drug rash or hives alone, can safely receive 3rd and 4th generation cephalosporins.
• In hospitalized patients with a presumed Gram-negative infection, use of two different classes of antibiotics
as empiric treatment may be indicated in cases with septic shock, respiratory failure, intravenous antibiotics
in the prior 90 days, and/or structural lung disease (e.g. bronchiectasis, cystic fibrosis). Otherwise,
monotherapy is typically appropriate when selecting an antibiotic for which resistance on the local
antibiogram is <10%.
The NH DPHS HAI Program is a resource for guidance in developing and strengthening your facilities stewardship
program, please contact us at haiprogram@dhhs.nh.gov or (603) 271-4496.
1
ARAW is a group of subject matter experts and stakeholders across the State of New Hampshire who meet regularly to discuss and
work to combat issues of antimicrobial resistance in NH. This is a forum for stakeholder input facilitated by NH DPHS.
NH Department of Health and Human Services October 2018
Division of Public Health Services
-7-
New Hampshire Statewide Antibiogram 2017 Bureau of Infectious Disease Control
Infectious Disease Surveillance Section
All Sources Other Than Urine
Percent Susceptible
Tetracycline (Doxycycline)
Tigecycline
Ampicillin/Sulbactam
Piperacillin/Tazobactam
Ampicillin (Amoxicillin)
Gentamicin
Levofloxacin
Amikacin
Tobramycin
Ciprofloxacin
Cefuroxime
Ceftriaxone
Ceftazidime
Cefepime
Cefoxitin
Imipenem
Meropenem
Doripenem
Trimethoprim/Sulfamethoxazole
Aztreonam
Ertapenem
Total Number of Isolates
Cefazolin (Cephalexin)
Gram Negative Organisms
Tetracycline (Doxycycline)
Vancomycin
Ampicillin/Sulbactam
Ampicillin (Amoxicillin)
Penicillin
Oxacillin
Moxifloxacin
Levofloxacin
Clindamycin
Erythromycin (Azithromycin)
Daptomycin
Cefuroxime
Ceftriaxone
Linezolid
Rifampin
Trimethoprim/Sulfamethoxazole
Total Number of Isolates
Cefazolin (Cephalexin)
Methicillin-Sensitive Staphylococcus aureus (MSSA) 7759 13 100 100 100 --- 100 93 96 95 98 80 100 100 100 99
Methicillin-Resistant Staphylococcus aureus (MRSA) 3598 57 70 94 97 68 100 100 100 99
Enterococcus faecalis 1100 99 99 --- 98 99 100
Enterococcus faecium 156 23 29 --- 39 97 94
Enterococcus spp. (all hospital data) 1642 91 92 --- 92 99 99
Coagulase negative Staphylococcus 1727 8 52 52 53 52 69 77 85 69 67 100 100 100 99
Streptococcus pneumoniae (non-meningitis) 445 85 --- --- --- 79 98 98 100 81 80 83 59 100 100
Indicates data have been censored because of intrinsic resistance and/or inappropriate clinical use.
--- Indicates data have been censored because of insufficient sample. CLSI guidelines suggest total isolate counts of less than 30 are excluded.
Cefuroxime
Ceftriaxone
Meropenem
Cefoxitin
Trimethoprim/Sulfamethoxazole
Tigecycline
Cefepime
Ciprofloxacin
Levofloxacin
Ceftazidime
Ampicillin (Amoxicillin)
Tetracycline (Doxycycline)
Cefazolin (Cephalexin)
Imipenem
Aztreonam
Ertapenem
Doripenem
Total Number of Isolates
Amikacin
Gentamicin
Ampicillin/Sulbactam
Tobramycin
Piperacillin/Tazobactam
Gram Negative Organisms
1516/ 1513/ 2594/ 2153/ 1639/ 1486/ 2522/ 2016/ 2551/ 1818/ 2531/ 2074/ 1420/ 634/ 2223/ 1598/ 1802/ 2396/ 2272/ 1419/ 1124/ 2110/
2669
Escherichia coli 2518 2337 2663 2453 1811 1576 2660 2113 2661 1929 2534 2074 1422 634 2645 1897 1808 2570 2421 1423 1446 2639
115/ 112/ 104/ 135/ 93/ 134/ 105/ 63/ 49/ 133/ 97/ 109/ 134/ 131/ 87/ 82/ 129/
129
Enterobacter aerogenes (Klebsiella aerogenes) 131 134 123 135 101 135 105 69 49 134 98 110 135 132 88 90 129
572/ 516/ 459/ 609/ 423/ 598/ 512/ 282/ 208/ 617/ 442/ 503/ 623/ 576/ 364/ 368/ 602/
634
Enterobacter cloacae 614 628 519 633 487 613 514 289 209 633 447 505 634 583 375 408 631
691/ 818/ 734/ 586/ 513/ 830/ 681/ 811/ 625/ 827/ 679/ 443/ 205/ 830/ 563/ 607/ 841/ 753/ 470/ 405/ 793/
858
Klebsiella pneumoniae 779 839 784 634 546 857 702 832 645 828 679 443 205 857 579 612 858 775 478 461 852
321/ 418/ 231/ 324/ 309/ 435/ 373/ 431/ 356/ 439/ 371/ 201/ 139/ 445/ 307/ 349/ 443/ 410/ 266/ 258/ 427/
446
Klebsiella oxytoca 405 431 400 352 316 445 380 446 365 439 371 201 139 446 308 349 446 414 266 276 446
463/ 476/ 599/ 490/ 415/ 345/ 589/ 456/ 593/ 417/ 568/ 472/ 150/ 495/ 352/ 402/ 552/ 477/ 504/
601
Proteus mirabilis 568 525 601 546 428 355 601 462 601 434 568 472 150 594 409 404 596 511 593
324/ 378/ 280/ 403/ 285/ 404/ 354/ 158/ 108/ 413/ 282/ 334/ 420/ 353/ 245/ 21/ 404/
424
Serratia marcescens 376 422 333 405 328 406 355 164 108 424 284 336 424 388 250 228 413
152/ 131/ 119/ 158/ 126/ 156/ 137/ 71/ 154/ 109/ 135/ 151/ 147/ 110/ 91/ 150/
159 ---
Citrobacter freundii 158 157 137 159 139 158 138 75 159 113 136 159 152 111 106 160
11/ 183/ 112/ 163/ 141/ 183/ 135/ 184/ 155/ 62/ 155/ 116/ 158/ 162/ 169/ 12/ 26/ 153/
186
Morganella morganii 171 186 127 185 162 186 156 185 155 65 185 130 159 185 179 121 121 183
1507/ 1376/ 1295/ 940/ 1203/ 722/ 426/ 1352/ 954/ 1107/ 1392/ 1367/
1562
Pseudomonas aeruginosa 1556 1466 1411 1126 1263 789 435 1555 1113 1133 1556 1407
130/ 86/ 140/ 135/ 128/ 154/ 101/ 111/ 153/ 146/ 82/ 145/
165 --- --- --- ---
Acinetobacter baumannii 152 163 149 148 133 164 105 113 165 153 93 165
145/ 225/ 344/
355
Stenotrophomonas maltophilia 304 280 355
157/ 133/ 105/
293 --- --- --- --- --- ---
Haemophilus influenzae 219 133 138
Moxifloxacin
Cefuroxime
Ceftriaxone
Trimethoprim/Sulfamethoxazole
Oxacillin
Levofloxacin
Ampicillin (Amoxicillin)
Tetracycline (Doxycycline)
Cefazolin (Cephalexin)
Total Number of Isolates
Penicillin
Ampicillin/Sulbactam
Clindamycin
Vancomycin
Linezolid
Daptomycin
Rifampin
Erythromycin (Azithromycin)
Gram Positive Organisms
821/ 7753/ 6156/ 5870/ 4833/ 7063/ 6034/ 7173/ 7471/ 5871/ 7582/ 6435/ 6337/ 7304/
7759 ---
Methicillin-Sensitive Staphylococcus aureus (MSSA) 6370 7758 6213 5928 4855 7580 6316 7586 7591 7325 7582 6444 6350 7354
2000/ 1999/ 3307/ 3406/ 2327/ 3614/ 3077/ 3171/ 3408/
3598
Methicillin-Resistant Staphylococcus aureus (MRSA) 3514 2855 3520 3524 3402 3614 3078 3176 3439
850/ 1091/ 1073/ 887/ 916/
1100 ---
Enterococcus faecalis 857 1100 1095 894 918
30/ 45/ 61/ 128/ 112/
156 ---
Enterococcus faecium 133 156 156 132 119
1245/ 1504/ 1512/ 1396/ 1354/
1642 ---
Enterococcus spp. (all hospital data) 1375 1641 1636 1412 1364
103/ 855/ 609/ 580/ 483/ 1177/ 989/ 1445/ 1124/ 1088/ 1716/ 1414/ 1373/
1727
Coagulase negative Staphylococcus 1283 1639 1170 1104 925 1704 1283 1704 1637 1630 1720 1417 1377
345/ 118/ 345/ 300/ 88/ 205/ 189/ 141/ 164/ 270/ 87/
Streptococcus pneumoniae (non-meningitis) 445 407 --- --- --- 150 352 305 88 253 235 170 276 270 87
Indicates data have been censored because of intrinsic resistance and/or inappropriate clinical use.
--- Indicates data have been censored because of insufficient sample. CLSI guidelines suggest total isolate counts of less than 30 are excluded.
Tigecycline
Cefuroxime
Ceftriaxone
Ceftazidime
Cefepime
Aztreonam
Meropenem
Imipenem
Levofloxacin
Cefoxitin
Ertapenem
Doripenem
Ciprofloxacin
Amikacin
Gentamicin
Tobramycin
Piperacillin/Tazobactam
Trimethoprim/Sulfamethoxazole
Nitrofurantoin
Ampicillin (Amoxicillin)
Tetracycline (Doxycycline)
Cefazolin (Cephalexin)
Total Number of Isolates
Gram Negative Organisms
Ceftriaxone
Levofloxacin
Moxifloxacin
Clindamycin
Vancomycin
Linezolid
Daptomycin
Penicillin
Oxacillin
Rifampin
Nitrofurantoin
Trimethoprim/Sulfamethoxazole
Ampicillin (Amoxicillin)
Cefazolin (Cephalexin)
Tetracycline (Doxycycline)
Total Number of Isolates
Methicillin-Sensitive Staphylococcus aureus (MSSA) 711 18 100 100 100 93 82 98 98 76 100 100 100 99
Methicillin-Resistant Staphylococcus aureus (MRSA) 393 21 21 94 94 41 100 100 99 98
Enterococcus faecalis 2806 99 99 98 99 100 99
Enterococcus faecium 299 17 20 44 97 90 39
Enterococcus spp. (all hospital data) 4625 92 93 94 99 99 94
Indicates data have been censored because of intrinsic resistance and/or inappropriate clinical use.
--- Indicates data have been censored because of insufficient sample. CLSI guidelines suggest total isolate counts of less than 30 are excluded.
Tigecycline
Levofloxacin
Total Number of Isolates
Cefoxitin
Amikacin
Gentamicin
Tobramycin
Nitrofurantoin
Ceftriaxone
Cefepime
Ciprofloxacin
Cefuroxime
Ceftazidime
Aztreonam
Ertapenem
Imipenem
Doripenem
Ampicillin (Amoxicillin)
Meropenem
Tetracycline (Doxycycline)
Trimethoprim/Sulfamethoxazole
Piperacillin/Tazobactam
Cefazolin (Cephalexin)
Gram Negative Organisms
18185/ 29241/ 27164/ 20889/ 18437/ 28521/ 23684/ 28858/ 23783/ 28414/ 23888/ 15079/ 9038/ 25951/ 19061/ 21165/ 27817/ 25705/ 18372/ 15075/ 23707/ 28594/
29741
Escherichia coli 28177 29700 29682 22261 19157 29719 24658 29722 24710 28518 23939 15122 9038 29661 21787 21276 29704 27221 18398 18517 28558 29164
466/ 450/ 377/ 518/ 410/ 512/ 415/ 254/ 174/ 504/ 397/ 398/ 519/ 487/ 323/ 330/ 506/ 99/
521
Enterobacter aerogenes (Klebsiella aerogenes) 506 520 425 520 448 515 415 271 174 521 407 398 521 488 327 361 520 514
671/ 611/ 535/ 782/ 588/ 760/ 666/ 392/ 224/ 774/ 567/ 634/ 789/ 734/ 481/ 450/ 722/ 258/
797
Enterobacter cloacae 783 792 650 797 711 784 671 406 224 797 581 634 797 743 490 503 794 776
4934/ 4912/ 3614/ 3161/ 5011/ 4195/ 5033/ 4155/ 4937/ 4152/ 2619/ 1506/ 4983/ 3629/ 3770/ 5071/ 4653/ 3156/ 2746/ 4748/ 2406/
5152
Klebsiella pneumoniae 5048 5145 3906 3333 5148 4299 5148 4269 4956 4166 2625 1516 5145 3719 3788 5148 4758 3190 3163 5135 5044
763/ 367/ 541/ 503/ 790/ 654/ 806/ 658/ 820/ 623/ 439/ 281/ 807/ 622/ 621/ 812/ 734/ 511/ 504/ 782/ 699/
825
Klebsiella oxytoca 793 734 607 523 823 671 824 683 821 623 439 281 824 629 621 825 749 512 539 824 814
1696/ 2262/ 2062/ 1673/ 1425/ 2231/ 1922/ 2241/ 1707/ 2155/ 1776/ 669/ 1729/ 1341/ 1622/ 2037/ 1940/ 1789/
2282
Proteus mirabilis 2182 2275 2272 1694 1444 2281 1946 2281 1751 2155 1776 675 2262 1691 1630 2277 2110 2266
261/ 292/ 234/ 322/ 218/ 302/ 274/ 123/ 96/ 297/ 222/ 255/ 318/ 279/ 196/ 11/ 319/
327
Serratia marcescens 284 324 273 327 240 306 275 128 96 327 233 256 327 309 197 198 327
710/ 652/ 549/ 764/ 577/ 724/ 659/ 360/ 236/ 735/ 531/ 577/ 749/ 689/ 487/ 410/ 669/ 743/
782
Citrobacter freundii 763 782 642 769 657 726 659 369 236 782 555 577 781 715 489 475 756 778
261/ 139/ 250/ 192/ 262/ 191/ 265/ 208/ 83/ 219/ 164/ 229/ 242/ 240/ 5/ 27/ 228/
265
Morganella morganii 264 166 265 213 265 209 265 209 84 264 186 229 265 252 141 168 264
1844/ 1747/ 1638/ 1088/ 1527/ 920/ 460/ 1544/ 1080/ 1219/ 1649/ 1762/
1909
Pseudomonas aeruginosa 1904 1861 1771 1304 1614 998 471 1895 1347 1254 1895 1833
36/ 60/ 57/ 64/ 78/ 155/ 49/ 77/ 75/ 49/ 72/
89 --- 85 67 67 67 --- --- 86 161 54 88 81 --- 57 88
Acinetobacter baumannii
Levofloxacin
Total Number of Isolates
Penicillin
Nitrofurantoin
Oxacillin
Clindamycin
Vancomycin
Linezolid
Daptomycin
Rifampin
Moxifloxacin
Ceftriaxone
Ampicillin (Amoxicillin)
Tetracycline (Doxycycline)
Trimethoprim/Sulfamethoxazole
Cefazolin (Cephalexin)
106/ 680/ 495/ 361/ 551/ 75/ 655/ 680/ 104/ 92/ 692/ 648/ 527/
711
Methicillin-Sensitive Staphylococcus aureus (MSSA) 590 680 495 361 690 92 692 691 137 130 692 650 528
77/ 14/ 348/ 350/ 35/ 8/ 384/ 373/ 315/
393
Methicillin-Resistant Staphylococcus aureus (MRSA) 373 68 383 372 85 83 384 374 317
1965/ 2781/ 39/ 2728/ 2611/ 1007/
2806
Enterococcus faecalis 1979 2803 378 2785 2639 1869
41/ 57/ 1/ 131/ 277/ 39/
299
Enterococcus faecium 247 287 30 296 285 222
3422/ 4265/ 61/ 4324/ 4378/ 1692/
Enterococcus spp. (all hospital data) 4625 3732 4599 604 4589 4441 3352
Indicates data have been censored because of intrinsic resistance and/or inappropriate clinical use.
--- Indicates data have been censored because of insufficient sample. CLSI guidelines suggest total isolate counts of less than 30 are excluded.
Reporting requirements are governed by RSA 141:C6 with authority given to DHHS to develop administrative rules to
provide specific reporting instructions and methodology. Administrative rules He-P 301 were adopted in fall 2016 “He-P
300 Diseases, PART He-P 301.02 Communicable Diseases,” were updated in 2016 with stakeholder input and approved
by the Joint Legislative Committee on Administrative Rules. The updated rules require hospital laboratories to report
antibiogram data annually to the State of New Hampshire.
NH DPHS developed a standardized antibiogram fillable form for reporting susceptibility data, and requested data from
hospital microbiology laboratories in January 2018. This form was developed to encompass most relevant antibiotic and
organism combinations, created in collaboration between the NH DPHS and stakeholder subject matter experts. All 26
NH hospitals reported antibiogram data as required under He-P301; along with the Veteran’s Affairs Hospital whom
voluntarily reported data.
The HAI Program reconciled data to confirm reported data and evaluate accuracy and reliability of the data. The HAI
Program first conducted an internal assessment to identify outliers or implausible data by comparing the percent
susceptibilities between all hospitals for every organism and antibiotic combination and then corrected or confirmed
data with each respective microbiology laboratory. The program subsequently convened an infectious disease medical
and pharmacy advisory group to review the clinical implications of the data and ensure data was clinically accurate and
relevant. The advisory group determined which antibiotic-organism combinations to censor due to clinical
inappropriateness. Lastly, the antibiogram data was reviewed by the NH Antimicrobial Resistance Advisory Workgroup
(ARAW) 2 to provide feedback and suggestions for use.
Antibiogram Development:
The Clinical and Laboratory Standards Institute (CLSI) guidelines were followed in the aggregation of data from all
reported hospital antibiograms. Antibiotic and organism combinations that are either intrinsically resistance or not
clinically appropriate were censored from the antibiogram. Per CLSI guidelines, any antibiotic and organism combination
with a total number of isolate counts of less than 30 isolates were excluded.
An ARAW subcommittee, made up of infectious disease clinical specialists, drafted and reviewed the antibiogram
executive summary to assist with clinical interpretation. The summary focused on treatment of common infections
syndromes and was based on review of NH antibiogram data and current national treatment guidelines
(https://www.idsociety.org/PracticeGuidelines/).
2
ARAW is a group of subject matter experts and stakeholders across the State of New Hampshire who meet regularly to discuss and
work to combat issues of antimicrobial resistance in NH. This is a forum for stakeholder input facilitated by NH DPHS.
NH Department of Health and Human Services October 2018
Division of Public Health Services
-12-
Data Limitations
Antibiotic susceptibility data from regional reference labs is not included in this data set and therefore the
antibiogram is limited in its representativeness to hospital laboratory isolates.
The urine only antibiogram includes all urine isolates, not necessarily only those pertaining to urinary tract
infections. These isolates may represent other types of infections where bacteria were cultured from other clinical
isolates in addition to the urine (e.g. bacteremia with seeding of the urine).
The lack of reported susceptibility results for an antibiotic against a specific organism doesn’t necessarily mean
that the antibiotic isn’t active. In some cases activity is reliably predicted by the activity of another agent (e.g.
cefazolin activity against Staphylococcus aureus is predicted by oxacillin susceptibility); while in some other cases
it is not possible to test susceptibility due to lack of testing reagents. Conversely, reported activity on in vitro
susceptibility results does not necessarily mean an agent is clinically effective (or as effective as alternatives). For
example, ciprofloxacin may show in vitro activity against Staphylococcus aureus, but ciprofloxacin should never be
used to treat infections caused by this organism. This is because of the potential for rapid development of
resistance while being treated with ciprofloxacin.
The values presented in the antibiogram are rounded and do not show exact values.
Note: All the data in this report are based upon information provided to the New Hampshire Department of Health and
Human Services under specific legislative authority. The numbers reported may represent an underestimate of the true
absolute number in the state. Any release of personal identifying information is conditioned upon such information
remaining confidential. The unauthorized disclosure of any confidential medical or scientific data is a misdemeanor
under New Hampshire law. The department is not responsible for any duplication or misrepresentation of surveillance
data released in this report. Data are complete as of 10/01/18. Report prepared by the Healthcare-Associated
Infections Program, Infectious Disease Surveillance Section, haiprogram@dhhs.nh.gov, (603)-271-4496.
Acknowledgements
The New Hampshire State 2017 Antibiogram was facilitated and promoted by the ARAW, which is comprised of a diverse
group of stakeholders from around the state. We would like to thank the ARAW for their time and input into creating a
useful tool for clinicians and continuing antibiotic resistance surveillance in New Hampshire.
We would also like to thank the many people that contributed directly to the creation and clinical content outlined in
this report. Their work and input has been invaluable:
Hannah Leeman Benjamin Chan, MD, MPH Michael Calderwood, MD, MPH
Carly Zimmermann, MPH, MLS(ASCP)cm Elizabeth Talbot, MD Apara Dave, MD
Katrina Hansen, MPH Daniel Tullo, MS, SM (ASCP) Paul Santos, PharmD
Yvette Perron, MPH Rachelle Markham, MLS(ASCP)cm Erin Reigh, MD
Lisa Tibbitts, RN, BSN, MSNed, BC Maureen Collopy, MPH, MT(ASCP) Joshua White, MD