Background: Complicated urinary tract infections (cUTIs) lead to numerous hospital admissions, influencing both patient outcomes and healthcare costs. Regional data on the clinical and microbiological distinctions between catheter-associated and non-catheter-associated cUTIs are scarce. Aims & Objectives: This study addresses the gap by exploring the clinical features, microbial profiles, and treatment outcomes of cUTIs in a Pakistani hospital, differentiating between catheter-associated and non-catheter-associated infections. Methods: In this cross-sectional study, adult patients with cUTIs were analyzed for clinical symptoms, microbial cultures, and resistance patterns, adhering to the European Association of Urology’s guidelines. SPSS version 21 was used for statistical evaluation. Results: Out of 390 patients, most of whom were female (55.13%), the prevalent diagnosis was pyelonephritis (72.05%). Immunosuppression was present in a third, while urinary abnormalities were found in nearly half of the patients. The study found higher rates of abnormalities and recurrent UTIs in catheter-associated cases, which also tended to have longer hospital stays and increased ICU admissions and 30-day mortality. Conclusion: The findings shed light on the local clinical and resistance patterns of cUTIs, particularly in patients with catheter usage, emphasizing the need to reassess empirical treatments like ertapenem or fourth-generation cephalosporins for CAUTI.