Background: Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of upper urinary tract distinguished by the presence of gas in renal parenchyma and peri-renal tissue. There is a rapid increase in multi drug resistant strains across the globe, especially in the southeast asian region, including India, where extended-spectrum β-lactamase (ESBL) prevalence varies between 17% and 70%. Ceftriaxone and disodium ethylene diamine tetra acetic acid (EDTA) is a novel combination active against multidrug-resistant Gram-negative pathogens. Infections due to EPN and ESBL producers range from uncomplicated urinary tract infections to life-threatening sepsis. Methods: We investigated 11 cases in the present retrospective study. These patients were diagnosed as EPN produced by ESBL bacteria. The cases were followed from 6 to 20 months. Among the 11 patients 9 were female and 2 were male. All were diabetic and treated with 1 week ELORES followed by Faropenem for 7 days decreasing the chances of renal failure requiring haemodialysis and nephrectomy. The clinical and laboratory data, imaging findings, and microbiological patterns of 11 patients were recorded. Results: Of the 11 cases in the present study, 9 patients showed progress with 1 week of ELORES followed by Faropenem. 1 underwent percutaneous nephrostomy and delayed nephrectomy. 1 patient underwent Nephrectomy, Conclusion: The study clearly demonstrates the decreased nephrectomy rate when the drug combination is used. This retrospective study with a small sample number needs further validation with a multivariable analysis and with a higher number of cases.