TRIC-MAN

TRIC-MAN is a two week long, national audit of antimicrobial stewardship and resistance in critical care units across the UK. 

The project aims to evaluate adherence to UKHSA and NICE guidance, explore antimicrobial stewardship and infection prevention practices, and assess antimicrobial resistance in invasive priority pathogens and will be the first of its kind for over 20 years. 

It is being run by the Trainee Research in Intensive Care (TRIC) Network. 

For patients with sepsis, the Surviving Sepsis Campaign guidelines state that “early administration of appropriate antimicrobials is one of the most effective interventions to reduce mortality”. The use of antibiotics with insufficient antimicrobial coverage is associated with worse outcomes. This is against a backdrop of increasing antimicrobial resistance (AMR), a global threat to public health, responsible for over a million excess deaths worldwide.

It is over twenty years since the last national survey of antibiotic use specifically in Intensive Care Units (ICUs) in the UK. In this survey, 11% of patients had admission prescriptions changed due to antibiotic resistance and 13% of patients had multiple resistance. Given that around 70% of critically ill patients are treated with antibiotics and per-capita antibiotic use is highest in intensive care units in secondary care, it is essential to regularly evaluate the use of these drugs. 

There is also a high prevalence of antimicrobial resistance in ICUs across Europe and the rest of the world. However, comparatively little is known about the prevalence of AMR in ICUs in the UK. For example, resistance data for UK ICUs is not routinely reported by English surveillance programme for antimicrobial utilisation and resistance (ESPAUR), the European Centre for Disease Prevention and Control (ECDC) or the World Health Organisation. 

1. Evaluate adherence to UKHSA and NICE guidance for initiation and review of all antimicrobial prescriptions in critically ill patients in the UK
2. Explore antimicrobial stewardship and infection prevention and control practices in UK ICUs
3. Assess antimicrobial resistance in invasive priority pathogens in critically ill patients in the UK

• “Start smart then focus: antimicrobial stewardship toolkit for inpatient care settings” – UKHSA 2023 
• "Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use” – NICE 2015

The study will use a similar methodology to point prevalence surveys conducted by ESPAUR and the ECDC with additional data collected on antimicrobial resistance and reasons behind antimicrobial choices. 

The study will be conducted over a two-week period in March/April 2025 and should be a similar commitment to the recent TRIC projects ID-ACCT and NEAT-ECHO. 

All clinicians who contribute to data collection at a site will be named as a collaborator. Clinicians will also be able to use this as evidence of involvement in audit for ARCP or job applications.