A large number of hospital patients and primary care patients suffer from recurrent urinary tract infection (UTI) and urosepsis. Some of these patients end up in intensive care units with multi-organ failure. New draft guidance from the National Institute for Health & Care Excellence (NICE) states the following: 1) Patients should be advised on lifestyle changes and hygiene care, 2) No evidence has been found on the benefits of drinking cranberry juice, 3) In non-pregnant women narrow spectrum antibiotics should be used as first-line treatment e.g. nitrofurantoin or trimethoprim, 4) In lower UTI in pregnant women, back-up antibiotic prescription should be given, while waiting culture reports, 5) One-third of E. coli UTIs show a worrying resistance to common antibiotics, 6) Ideally, antibiotics should only be started after a positive midstream urine sample. Extended-spectrum beta-lactamases (ESBL) organisms are becoming the ‘super-bugs’ of urology. They usually require costly intravenous drugs, pressure on hospital beds and medical / nursing staff time. In everyday practice, microorganisms are showing unexpected and mysterious changes. We need to stay one step ahead of them.