Aim: The aim of this study was to determine the prevalence of Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in urinary tract infections (UTIs) among elderly patients and assess their clinical presentation, antibiotic sensitivity, and resistance patterns. Materials and Methods: This prospective observational study included 120 elderly patients aged 65 years and above with clinical signs of UTIs. Urine samples were cultured and analyzed for the presence of Enterobacteriaceae species. ESBL production was detected using the combination disc diffusion test, and antibiotic susceptibility was determined by the Kirby-Bauer disc diffusion method. Results: Out of 120 patients, 37.50% (n=45) were found to have ESBL-producing Enterobacteriaceae, while 62.50% (n=75) had non-ESBL-producing isolates. Escherichia coli was the most prevalent bacterium, accounting for 58.33% (n=70) of the total isolates. Antibiotic resistance was significantly higher in ESBL-producing isolates, with 77.78% resistant to ceftriaxone and 66.67% resistant to ciprofloxacin. Nitrofurantoin showed higher efficacy, with 44.44% of ESBL-producing isolates and 93.33% of non-ESBL isolates being sensitive. Previous antibiotic use was significantly associated with ESBL production (p<0.001). Conclusion: This study reveals a high prevalence of ESBL-producing Enterobacteriaceae in UTIs among elderly patients, with significant resistance to commonly used antibiotics. These findings highlight the need for targeted antibiotic therapies, enhanced infection control measures, and prudent antibiotic use to combat multidrug-resistant infections in this vulnerable population.