Nosocomial infections with extended-spectrum beta-lactamase (ESBL) producers, especially those caused by Klebsiella pneumoniae, have been associated with increased morbidity, mortality, length of hospital stay, and hospital costs. Unlike the nosocomial multidrug-resistant organisms, ESBL-producing Escherichia coli frequently spread in the community. The emergence of E. coli ESBL producers may have significant clinical implications, since it may reduce the therapeutic options for common illnesses such as urinary tract infections (UTIs) and bacteremia. ESBL-producing E. coli also cause a higher mortality rate than non-ESBL-producing isolates. Recent pilot surveillance studies have demonstrated that ESBL-producing strains are the main cause of community-onset UTIs worldwide. Because these organisms have shown a high resistance to cephalosporins, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole, the guidelines for UTI therapy should be revised. Recent data show that fosfomycin, nitrofurantoin, and β-lactam/β-lactamase inhibitors are potential alternatives for treating non-serious infections such as community-onset UTIs caused by ESBL producers. Although carbapenems were found to be the most effective antibiotics for ESBL producers, they should be used more prudently to prevent increasing selective pressure.