[Objective] The spatiotemporal changes and sustainable utilization of water resources ecological footprint were explored in the middle reaches of the Yangtze River to provide decision-making references for the sustainable utilization of water resources in this region and in other provinces, metropolitan areas, and river basins. [Methods] This study selected the Hubei, Hunan, and Jiangxi provinces in the middle reaches of the Yangtze River from 2011 to 2021 as the research subjects. Employing the water resource ecological footprint model, a spatiotemporal analysis was conducted on the ecological footprint and related indicators of the three provinces. Based on the pressure-state-response model framework, an evaluation index system for sustainable water resource utilization in the middle reaches of the Yangtze River region was developed. [Results] ① The per-capita water resource ecological footprint and ecological carrying capacity of the three provinces showed an overall increasing trend, with the ecological carrying capacity exceeding the ecological footprint, resulting in an overall ecological surplus. Jiangxi Province had the highest per-capita ecological surplus of water resources, ranging from 3.186 to 7.966, whereas Hubei Province had the lowest, ranging from 0.304 to 2.603. ② The ecological footprint of each water account in the three provinces was predominantly industrial followed by domestic. Although ecological environmental water had the smallest share, it showed the most significant increase, particularly in Hubei Province. ③ The ecological footprint of water resources per ten thousand GDP exhibited a significant downward trend, with Jiangxi Province having the highest value and Hubei Province having the lowest, and the gap between the two gradually narrowed each year. ④ The pressure, state, and response indices for sustainable water resource utilization in the three provinces generally exhibited declining, rising, and increasing trends, respectively. The comprehensive evaluation indices exhibited a fluctuating upward trend; however, the rate of increase was modest and the overall index values remained relatively low. [Conclusion] Continued efforts are required to enhance the rational use of water for industrial and domestic purposes, promote the utilization of ecological and environmental water, and develop advanced measures to achieve sustainable water resource utilization. These findings can serve as a decision-making reference for water resource sustainability in the middle reaches of the Yangtze River and other provinces, city clusters, or basin areas.