Introduction: This study aimed to examine the susceptibility profile of Escherichia coli in urinary tract infections (UTIs) among elderly diabetic patients to support judicious and evidence-based antibiotic use. Methods: From January 2021 to December 2022, urine culture results were analyzed to determine the distribution of pathogens, especially E. coli, and their drug susceptibility. Results:E. coli infection was the most prevalent infection in elderly diabetic patients with UTIs, accounting for 32.6% of cases. Moreover, this bacterium’s multiple resistance rate (38.3%) was significantly higher than other bacteria’s multiple resistance rate (χ2 = 81.644, p < 0.05). Compared to older diabetic patients with optimal glucose control (HbA1c ≤7.0%), patients with poor glycemic control (HbA1c >7.0%) had lower resistance rates to lactams, and urine pH values were higher (p < 0.05). Conclusion: The most common cause of UTIs is E. coli, with advanced age and diabetes being the main risk factors. To optimize UTI treatment safety and efficacy, antibiotics should be administered based on the patient’s age and blood glucose control.

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