Introduction: Urinary tract infections (UTIs) are among the most prevalent infectious diseases globally, with a significant burden in developing countries due to limited healthcare access and antibiotic resistance. The neutrophil to lymphocyte ratio (NLR) has emerged as a potential hematological marker reflecting systemic inflammation in bacterial infections. However, its correlation with specific uropathogens remains underexplored, particularly in Indonesian tertiary hospitals. Objective: To evaluate the association between neutrophil to lymphocyte ratio (NLR) and the pattern of bacterial isolates in urine cultures of UTI patients at Haji Adam Malik General Hospital. Methods: This cross-sectional observational study included 97 patients diagnosed with UTI between April and May 2025. Data were obtained from medical records, including NLR values and urine culture results. NLR was categorized as low (<1.0×10⁹/L), normal (1.0–17.5×10⁹/L), or high (>17.5×10⁹/L). Bacterial isolates were identified and classified. Statistical analysis using Chi-square or Fishers exact test determined the association between NLR and bacterial patterns. Results: Most patients (68.00%) had normal NLR values, while 27.80% had elevated and 4.10% had low NLR. Escherichia coliwas the most frequently isolated pathogen (71.10%), followed by Klebsiella spp. (10.30%), Staphylococcus saprophyticus(7.20%), Proteus spp. (4.10%)  Enterococcus spp. (4.10%), and Pseudomonas aeruginosa (3.10%). Although Proteus spp.and Enterococcus spp. were more commonly associated with elevated NLR, the association between NLR and specific bacterial isolates was not statistically significant (p = 0.08). Conclusion: The neutrophil to lymphocyte ratio varies among UTI patients but is not significantly associated with the type of uropathogen. While NLR may reflect systemic inflammation in certain bacterial infections, its standalone diagnostic value in predicting bacterial etiology remains limited. Further studies with larger populations and integration of additional biomarkers are warranted to clarify the role of NLR in UTI management.