Extended-spectrum beta-lactamase-producing Enterobacterales represent a growing global challenge in the management of urinary tract infections due to their increasing prevalence and complex resistance profiles. Epidemiological data demonstrate a marked rise in these organisms across both community and healthcare settings, with significant regional variability but consistently increasing trends worldwide. Escherichia coli and Klebsiella pneumoniae remain the most frequently implicated pathogens, contributing substantially to the global antimicrobial resistance burden. The production of extended-spectrum beta-lactamases enables these bacteria to inactivate a wide range of beta-lactam antibiotics, including third-generation cephalosporins, while frequently coexisting with resistance to other antimicrobial classes such as fluoroquinolones and aminoglycosides. This multidrug resistance significantly limits therapeutic options and complicates both empirical and targeted treatment strategies. As a result, inappropriate empirical therapy is common, particularly in regions with high prevalence, leading to increased rates of treatment failure, recurrence, prolonged hospitalization, and higher healthcare costs. Clinically, infections caused by these organisms are indistinguishable from those caused by non-resistant pathogens, making microbiological confirmation essential for accurate diagnosis and management. Urine culture and susceptibility testing remain the cornerstone of diagnosis, although rapid molecular techniques are emerging as valuable tools for early detection. Therapeutically, carbapenems remain the mainstay for severe infections, although concerns regarding resistance have driven the development of alternative agents and carbapenem-sparing strategies. In this context, antimicrobial stewardship, guided by local antibiograms and risk stratification tools, plays a critical role in optimizing treatment and improving outcomes.