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Background Herpes simplex virus (HSV) encephalitis is associated with adverse clinical outcomes in 50% of patients. The use and impact of adjunctive steroids in improving the prognosis of this devastating disease is unknown. Methods A multicenter international retrospective study of adults (age >15 years) with confirmed HSV encephalitis. An adverse clinical outcome was defined as death or survived with sequelae. Results A total of 438 adults with HSV encephalitis were enrolled. The mean age was 50.58 years (15.94, SD), 226 (51.6%) were female and 59 (13.5%) were immunosuppressed. New onset seizures were seen in 91 (20.8%) patients and the median Glasgow coma scale was 14 (13–15, IQR). A total of 73 (16.6%) patients received adjunctive steroids during their hospitalization. Adjunctive steroids were given more frequently to patients with fever (84.5% vs. 66.7%, P = 0.003), seizures (38.3% vs. 17.3%, P < 0.001), abnormalities on MRI (77.7% vs. 61.8%, P = 0.017), lower mean Glasgow coma scales (10.42 vs. 11.3, P = 0.013) and it was also associated with a longer length of stay (median duration of 23 days vs. 20 days, P = 0.012). Adjunctive steroids were not associated with an impact on adverse clinical outcomes (46.6% vs. 46.9%, P = 0.95). Conclusion Adjunctive steroids in HSV encephalitis are used more commonly in the sicker patients and are not associated with a benefit in clinical outcomes. Disclosures All authors: No reported disclosures.

337. The Use of Adjunctive Steroids in 438 Adults With Herpes Simplex Virus Encephalitis