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Background  Urinary tract infections (UTI) represent a substantial burden to the healthcare system. In the early 2000s annual UTI admissions numbered 100,000, and these infections resulted in over 1 million emergency department (ED) visits. While only a fraction of total UTI volume, the estimated cost of complicated (cUTI) to the healthcare system exceeded &3.5 billion. We set out to evaluate the contemporary burden of cUTI in the US in terms of ED visits annually.    Methods  We conducted a retrospective multicenter cohort study within the National Emergency Department (NEDS) database, a 20-percent stratified sample of all US hospital-based EDs, from 2012-2018, to explore characteristics of patients discharged with a cUTI diagnosis. We applied a previously published algorithm to identify cUTI using administrative coding. We applied survey methods to develop national estimates.Results  Among 3,010,997 ED visits with cUTI, 43.3% were female, and 59.0% were age 65 years or older. Commensurately, Medicare was the primary payor in 62.8% of the visits. The majority of the patients (59.1%) presented to metropolitan teaching hospitals, and plurality were in the Southern US (39.6%). There was a narrow range in the visits’ seasonal variation, from 6.4% occurring in February to 7.9% in October. cUTI was the principal diagnosis in 48.5% of all cUTI visits. In the remaining 51.5%, sepsis was the most common principal diagnosis (33.9%), but severe sepsis and septic shock codes each appeared in 4.9%. Of all cUTI ED visits, 21.4% had catheter-associated UTI. While only 19.8% had a code for pyelonephritis, 2,050,548 (68.1%) were admitted to the hospital. Mortality in the ED was 0.02%.    Conclusion  During the seven-year span, there were over 3 million ED visits for cUTI. Although fewer than 1 in 10 patients met criteria for severe sepsis/septic shock, approximately 2/3rds of cUTI patients presenting to the ED were subsequently hospitalized.    Disclosures    Marya Zilberberg, MD, MPH ,  Cleveland Clinic  (Consultant) J&J  (Shareholder) Lungpacer  (Consultant, Grant/Research Support) Merck  (Grant/Research Support) scPharma  (Consultant) Sedana  (Consultant, Grant/Research Support) Spero  (Grant/Research Support)  Brian Nathanson, PhD ,  Lungpacer  (Grant/Research Support) Merck  (Grant/Research Support) Spero  (Grant/Research Support)  Kate Sulham, MPH ,  Spero Therapeutics  (Consultant)  Andrew F. Shorr, MD, MPH, MBA ,  Merck  (Consultant)

1430. Descriptive Epidemiology of Emergency Department Visits with cUTI in the US, 2012-2018