Background An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services’ Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Methods Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. Results All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care–associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. Conclusions The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health–clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.

BackgroundAntibiotic-resistant infections have been identified as an urgent national health threat. In response, the New Hampshire Division of Public Health Services (DPHS) sought to develop a system for tracking antibiotic resistance statewide through use of hospital antibiograms to (1) proactively monitor resistance trends over time and geographic region, (2) promote antimicrobial stewardship in NH healthcare facilities, and (3) provide a tool for providers to help guide appropriate antibiotic prescribing.MethodsThrough statutory legislative authority, DPHS requires hospital laboratories to report antibiogram data annually. DPHS formed an advisory group, consisting of infectious disease, medical and pharmacy subject matter experts to develop a standardized data collection tool. DPHS validated reported data to confirm accuracy, and clarify aberrant data by comparing the susceptibilities among all hospitals. Any questionable data were verified with the respective laboratory. The combined data were reviewed by the clinical advisory group and recommendations were created from the antibiogram data to highlight appropriate antibiotic prescribing and the need for coordinated stewardship. The antibiogram and clinical recommendations were disseminated widely throughout the state.ResultsAll 26 hospitals in New Hampshire submitted data. A total of 42,519 and 21,306 bacteria were cultured from urine and non-urine sources, respectively. The clinical advisory group’s recommendations included interpretations and antibiotic therapy directives for common clinical syndromes. Dissemination was accomplished through a health alert, partnership with a state working group of stakeholders, widespread email communication and online publication.ConclusionThe small size of New Hampshire, centralized public health structure, and close working relationships with all hospitals allowed for efficient collection of these data. Our process may serve as a model for other states, and will inform more accurate, comprehensive antibiotic resistance surveillance. This antibiogram is the launch for a larger statewide public health antibiotic stewardship campaign and coincides with national efforts around antibiotic stewardship and resistance surveillance.Disclosures All authors: No reported disclosures.