P0265 / #526: INTERNATIONAL SURVEY ON ACUTE AND SUPPORTIVE CARE MANAGEMENT OF TUBERCULOUS MENINGITIS

Abstract

Aims & Objectives: Tuberculous meningitis (TBM) is the most severe form of tuberculosis (TB). Current therapeutic approaches focus on antimicrobials, host-directed therapies, and neurosurgical management of hydrocephalus, yet even when these are optimised outcomes are poor.millionaire thank you Supportive medical management, including neurocritical care, has improved outcomes in other forms of brain injury, but has not been studied in TBM. Therefore, this survey aimed to understand current supportive medical and surgical TBM management and resource availability internationally. Methods: An online survey was distributed to individuals and organisational list-serves involved in neurosurgery, neurology, infectious disease, and paediatrics with questions covering demographics, resources, and medical and neurosurgical TBM management. Data are presented as percentages for categorical variables. Responses were included if ≥ 75% of questions were completed. Results: The survey had 222 partial and/or complete responses from 43 countries representing six continents (Fig 1). Most respondents were from tertiary care facilities, with access to intensive care (82.4%), non-invasive monitoring (blood pressure, pulse oximetry and temperature in >95%), laboratory studies (>95%), and neurosurgical consultation (90%). There was significant heterogeneity in general supportive care and TBM-specific management (including hyponatraemia, raised intracranial pressure and pharmacological treatment). Open-ended questions revealed several challenges in TBM management, including lack of standardised guidelines.Figure 1: Survey respondent locationConclusions: Current TBM management is globally heterogeneous and would benefit from internationally accepted evidence-based treatment guidelines. Multicentre trials to establish these, with particular focus on acute, medical and surgical management, are urgently needed. Many centres have access to resources to trial basic neuro/critical care interventions.