Escherichia coli is able to develop resistance to a variety of antibiotics, leading to the production of extended-spectrum lactamases (ESBL-E. coli). The purpose of this study is to determine the prevalence of multidrug-resistant, ESBL-expressing Escherichia coli in Pakistani patients with urinary tract infections, as there are currently limited therapeutic options for ESBL-E.coli illnesses. Between January 2023 and December 2023, urine samples from patients with urinary tract infections (UTIs) were collected at Women Medical College in Abbottabad, Pakistan. The microbial species discovered in the samples were subsequently identified and cultured using standard biochemical techniques. A double-disc synergy test was used to identify ESBL-producing strains of E.coli and an in vitro method and the clinical laboratory standard institute (CLSI) criteria were used to determine the organisms' resistance to antibiotics. Patients without recurrent UTIs provided 200 specimens containing E.coli isolates; 56 (28%) of these specimens were ESBL-E.Coli, while 144 (72%) were non ESBL-E.coli. There were 25% male and 75% females. As compared to men, females were noticeably more prone to the UTI. The majority of the ESBL-E.coli isolates were sensitive to various carbapenems (imipenem, meropenem, and ertapenem), aminoglycosides (amikacin), and nitrofurantoins, while nearly all of the isolates were resistant to cephalosporins (ceftriaxone, cefotaxime, cefepime, cefuroxime, and cephalothin) and penicillin (ampicillin). The most common bacteria associated with UTIs, E.coli has developed antibiotic resistance, which is a major factor in selecting the right antibiotic treatment.