Infections caused by community-acquired (CA) extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae are an increasing public health concern. We report a 15-year-old girl with a history of recurrent urinary tract infections who developed a right renal abscess. Percutaneous abscess drainage and subsequent microbiological culture revealed CA-ESBL Escherichia coli. To our knowledge, this is the first reported pediatric case of CA-ESBL E coli renal abscess complicating urinary tract infection. Establishing a definitive diagnosis of ESBL E coli renal abscess may necessitate obtaining a microbiological culture via surgical specimen, especially in children with apparent risk factors for the selection of ESBL-producing organisms.