Gram-negative germs are associated with more severe wound pain, and alternative measures for treatment are needed, a new analysis shows.

Multidrug-resistant Gram-negative bacteria that causes infections has increased, reaching 62% of all infections in intensive care units, according to the latest available data. These germs often increase mortality risk and spike costs of treatment. But “there are no promising newly developed antibiotics or alternative treatment strategies” targeted against these germs, wrote researchers at St. Josef Hospital and Ruhr-University in Bochum, Germany.

The most common germs in leg ulcers specifically are Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Enterobacter cloacae. The goal of the German study was to find the frequency of Gram-negative germs in venous leg ulcers, study their resistance and examine the clinical course of the wound.

More than half the swabs examined had Gram-negative germs, and penicillin was found to be the antibiotic drug with the highest rate of resistance, researchers said.

Without good treatment options, providers are advised to be proactive against Gram-negative germs. Since these germs are often transmitted by “smear infections” from people and contaminated water, optimal hygiene is necessary, and may include water filters for wound cleansing.