Multiresistant E.coli infections are an important cause of gram negative septicaemia, especially in the elderly. These infections have steadily increased in the UK since 2003, both in hospital and in the community. They are resistant to many commonly used antibiotics and currently carbapenems are the only agents with reliable activity. Drs Sharada Gudur, Nawaraj Subedi, Ray George and John Chessbrough highlight the problem and discuss the management options.