Maternal death due to extended spectrum beta-lactamase-producing E. coli: a warning for the future?

We describe a maternal death due to necrotising fasciitis caused by an extended spectrum beta-lactamase-producing Escherichia coli resistant to routinely used antimicrobial agents. Necrotising fasciitis is a rare complication of septicaemia with a high mortality. Signs of infection were insidious and masked by the use of routine analgesic agents and concurrent preeclampsia. The incidence of infection with extended spectrum beta-lactamase-producing organisms is increasing both in the United Kingdom and globally and will need to be considered in the obstetric setting. The use of the current Modified Early Warning Scores was of limited help in this case. Where there is no response to routine antibiotics within 12h, microbiological review is indicated.