Background Community-acquired urinary tract infection (UTI) is the most common bacterial infection encountered at hospitals. Effective empirical antibiotic therapy relies on updated epidemiological data. Aim We described the epidemiology of patients with urosepsis presenting to a community hospital in Taiwan in order to assess the appropriateness of empirical therapy. Methods Retrospective cohort study of hospitalized adult patients with UTI from January 1 to December 31 in 2010. The clinical and microbiological characteristics were analyzed using descriptive statistics. Logistic regression analysis was performed to determine predictors of antibiotic resistance. Findings A total of 420 consecutive patients with 599 isolates were identified. Most patients were >=65 years old and women (75.4%), and 114 patients (27.1%) had bacteremia. Escherichia coli (69%) was the most common organism. Cefazolin was effective against E. coli, K. pneumoniae, and P. mirabilis in greater than 80% of the cases. In male patients, urinary catheter and renal stone were independent predictors for cefazolin resistance; while diabetes mellitus and malignancy were predictors among female patients. Conclusion Patients admitted with UTI should be screened to identify risk factors for bacteremia and antimicrobial resistance. The treatment guideline in Taiwan needs to be revised in the current era of increasing antimicrobial resistance.