343. Compliance to Standard of Care in the Diagnosis and Management of Suspected Encephalitis

BACKGROUND: Encephalitis is associated with death or neurological disability in 50% with the majority of the patients having an unknown etiology. The IDSA guidelines on the management of encephalitis were published in August 2008 but compliance with their recommendations is unknown. METHODS: A retrospective study was conducted at 17 hospitals in the Great Houston area from August 2008 through July 2015. All cases met the definition for possible or probable encephalitis as per the international encephalitis consortium recommendations. Data extraction from the medical record was done utilizing a standardized form. Extracted data included information on demographics, clinical presentation, diagnostic testing, and treatment. RESULTS: A total of 264 adults and children with encephalitis were enrolled. Compliance with IDSA guidelines was excellent for obtaining an MRI of the brain (92%), an electroencephalogram (92%) and obtaining a cerebrospinal fluid (CSF) bacterial culture (86.7%). Empirical antibiotic and acyclovir therapy was started in about 65% of patient with a CSF HSV PCR being done in 78.8%. A CSF VZV PCR was only done in 31.4% while an arboviral serology was done in 57.1% of patients. Compliance was lowest in ordering a CSF N-methyl-d-aspartate receptor antibody (NMDA) and voltage-gated potassium channel (VGKC) antibodies (19.3% and 5.6%, respectively). The tests with the highest yield were a CSF NMDA receptor antibody (39.2%) and a CSF VZV PCR (13.2%). CONCLUSION: Diagnostic evaluation of patients with encephalitis and compliance with IDSA guidelines is suboptimal. DISCLOSURES: All authors: No reported disclosures.