A global week to raise awareness of the dangers of antibiotic resistance

Antibiotic resistance is one of the most serious threats to public health worldwide. According to the WHO, unless urgent measures are taken, this scourge could cause more than ten million deaths a year by 2050. 

Although with proper use, antibiotics remain a major medical advance, their abuse and misuse contribute to antibiotic resistance by encouraging the emergence of resistant bacteria, which puts at risk. Despite this, only 31% of the French public says it is aware of the negative impact of antibiotics on the microbiota, according to the International Microbiota Observatory, a survey conducted in 2024 by Ipsos for the Biocodex Microbiota Institute. For the second year running, the Biocodex Microbiota Institute has commissioned Ipsos to carry out a major international survey on 7,500 individuals across 11 countries in order to better understand people’s level of knowledge and behaviors when it comes to their microbiota.

Against this worrying backdrop, World AMR Awareness Week represents a crucial opportunity to raise awareness among the public and healthcare professionals about the importance of proper antibiotic use.

Antimicrobial resistance awareness mural to get the message across to patients

Over the past five years, the Biocodex Microbiota Institute has played an active role in this global awareness campaign, with multiple initiatives to promote the proper use of antibiotics and raise awareness among the general public and healthcare professionals of their impact on microbiota. For the 2024 edition, teams from the Biocodex Microbiota Institute worked alongside Querceo to create the first “antibiotic resistance awareness mural.”

Training 1,700 “Biocodex Mural Makers” to animate a first-rate community of ambassadors

The campaign kicked off on November 14 with a scientific conference entitled “Antibiotic resistance: microbiota at the heart of a silent pandemic”, featuring, among others, Vanessa Carter, survivor of antibiotic resistance and member of the WHO working group on antibiotic resistance, and Professor Etienne Ruppé, specialist in antibiotic resistance and bacteriologist at the Bichat-Claude Bernard hospital in Paris.

As part of this awareness-raising week, Biocodex is also mobilizing its 1,700 employees for the initiative. Participative workshops will be organized throughout the week of November 18 to 24 to train employees on how to design the antibiotic resistance awareness mural. These workshops provide an opportunity for exchange and co-creation, to reinforce collective awareness about the proper use of antibiotics. 

For Catherine Perret, Chief People Officer at Biocodex, “training our 1,700 employees on how to design this mural reinforces their commitment to raising awareness about antibiotic resistance. This makes them active ambassadors for the cause, helping to spread the importance of the proper use of antibiotics.”

Some transgender (sidenote: Transgender A person whose gender identity, i.e. their intimate and personal experience of their gender, differs from the sex assigned to them at birth. WHO, MSD Manual, Government of Canada ) women correct the gender incongruity (sidenote: Gender incongruence Marked and persistent incongruence between an individual’s experienced gender and assigned sex, which often leads to a desire to ‘transition’ through hormonal treatment, surgery or other health care services. WHO, MSD Manual, Government of Canada ) of feeling like a woman in the depth of their being despite the physical presence of male genitalia and being referred to as a man by undergoing “penile inversion vaginoplasty.” In other words, by surgically transforming their penis into a vagina. However successful the surgery, the skin of this newly constructed vagina will combine skin from the penis and a skin graft from the scrotum (sidenote: Scrotum Skin that protects the testicles in men WHO ) and/or other area(s) (stomach, groin, etc.).

How does this affect health? Vaginal microbiota makes a crucial contribution to good vaginal health in cisgender (sidenote: Cisgender A person whose gender identity aligns with the sex assigned to them at birth. WHO, MSD Manual, Government of Canada ) women. And American researchers have now turned their attention to the intimate flora of transgender women undergoing surgery: might the composition of neovaginal microbiota explain certain problems, including the frequently reported issue of vaginal discharge?

Cisgender vs. transgender vaginal microbiota: what are the differences?

It is a question worth asking, and one that has now been answered thanks to a study comparing the vaginal microbiota of transgender women undergoing vaginoplasty with that of cisgender women. The results? They have very different microbiota.

The vaginal flora of cisgender women is not very diverse and is dominated largely by lactobacilli, which creates an acidic environment that repels pathogens. That of transgender women has less than 3% of these precious allies and is much more diverse. Diversity in the vagina is not a sign of good health; quite the opposite. It is observed in cisgender women suffering from bacterial vaginosis, which increases risk of sexually transmitted infections (including HIV/AIDS) and miscarriage. 

How is this new microbial ecosystem created?

Or more precisely, which bacteria make up the neovaginal microbiota of transgender women having undergone surgery? They result no doubt from the flora of the skin (penis, scrotum, etc.) used during surgery. However, oral-genital and genital-genital transmission also appear to be involved.

In fact, the neovaginal flora of transgender women having undergone surgery has been shown to include bacterial species typical not only of the skin and digestive tract, but also of the mouth. Since sexual relations influence the likelihood of a bacterium called E. faecalis, there is also genital transfer.

On the other hand, while the proliferation of protective lactobacilli in cisgender women can be explained by hormones, the hormonal status of transgender women (comparable to that of cisgender women due to treatment) seemed to make no difference. Further studies on larger numbers of transgender women will be needed to better understand their neovaginal health.

Newborn babies acquire some of their mother’s vaginal and fecal flora during birth. However, in Cesarean births, this initial seeding is disrupted, facilitating colonization by pathogens.

Many questions remain about this initial digestive flora. For example, what are the seeding dynamics of the GI system? Where do the additional microorganisms come from, given that the child shares only half of its microbiota with its mother?

Suspecting that father plays a role, scientists ¹ have investigated gut flora sharing and transmission dynamics between mother and child and father and child. They did so by studying data for 53 families of infants born by vaginal delivery and 21 by cesarean section from the Finnish HELMi ² longitudinal cohort, as well as data for 7 families from the SECFLOR ³ cohort (children born by Cesarean section and subject to FMT (sidenote: Fecal Microbiota Transplantation (FMT) A therapeutic procedure to restore the gut microbiota by transferring fecal bacteria from a healthy donor to a recipient. Explore https://www.science.org/doi/10.1126/scitranslmed.abo2750 ) ).

Paternal microbiota: stable and complementary

Samples taken from infants, mothers, and fathers suggest that transmission of the paternal gut microbiota complements maternal seeding.

What’s more, the father is a major source: by the time the child blows out its first candle, his contribution is comparable to that of the mother. The study also shows that overlap between paternal and maternal strains is rare, underlining the complementarity of these two sources in the construction of the infant microbiota early in life. 

These data underline the father’s key role as a source of microorganisms. This role is all the more important given that, in Cesarean deliveries, only the mother receives antibiotic prophylaxis. The father’s untouched flora thus becomes essential.

Fecal rather than vaginal FMT

While transfers of maternal vaginal microbiota, which is less diverse than gut microbiota, had previously shown limited benefit, this study also highlights the value of FMT of maternal fecal microbiota, which offsets the effects of Cesarean section:  

• the microbial richness of the newborn’s microbiota is restored, with an increase in Bacteroides (B. dorei, B. fragilis and B. vulgatus) and Bifidobacterium (B. adolescentis, B. pseudocatenulatum and B. longum), 
• colonization by pathogens such as Clostridium perfringens, Enterococcus faecalis, Klebsiella oxytoca, Klebsiella pneumoniae is reduced,
• the effects persist over time (at least one year).

Furthermore, the researchers observed preferential colonization by bacteria capable of breaking down the sugars in breast milk. All of these strains could potentially be developed into future probiotics for newborns.

A global week to raise awareness of the dangers of antibiotic resistance

Antibiotic resistance is one of the most serious threats to public health worldwide. According to the WHO, unless urgent measures are taken, this scourge could cause more than ten million deaths a year by 2050. 

Although with proper use, antibiotics remain a major medical advance, their abuse and misuse contribute to antibiotic resistance by encouraging the emergence of resistant bacteria, which puts at risk. Despite this, only 31% of the French public says it is aware of the negative impact of antibiotics on the microbiota, according to the International Microbiota Observatory, a survey conducted in 2024 by Ipsos for the Biocodex Microbiota Institute. For the second year running, the Biocodex Microbiota Institute has commissioned Ipsos to carry out a major international survey on 7,500 individuals across 11 countries in order to better understand people’s level of knowledge and behaviors when it comes to their microbiota.

Against this worrying backdrop, World AMR Awareness Week represents a crucial opportunity to raise awareness among the public and healthcare professionals about the importance of proper antibiotic use.

Antimicrobial resistance awareness mural to get the message across to patients

Over the past five years, the Biocodex Microbiota Institute has played an active role in this global awareness campaign, with multiple initiatives to promote the proper use of antibiotics and raise awareness among the general public and healthcare professionals of their impact on microbiota. For the 2024 edition, teams from the Biocodex Microbiota Institute worked alongside Querceo to create the first “antibiotic resistance awareness mural.”

Training 1,700 “Biocodex Mural Makers” to animate a first-rate community of ambassadors

The campaign kicked off on November 14 with a scientific conference entitled “Antibiotic resistance: microbiota at the heart of a silent pandemic”, featuring, among others, Vanessa Carter, survivor of antibiotic resistance and member of the WHO working group on antibiotic resistance, and Professor Etienne Ruppé, specialist in antibiotic resistance and bacteriologist at the Bichat-Claude Bernard hospital in Paris.

As part of this awareness-raising week, Biocodex is also mobilizing its 1,700 employees for the initiative. Participative workshops will be organized throughout the week of November 18 to 24 to train employees on how to design the antibiotic resistance awareness mural. These workshops provide an opportunity for exchange and co-creation, to reinforce collective awareness about the proper use of antibiotics. 

For Catherine Perret, Chief People Officer at Biocodex, “training our 1,700 employees on how to design this mural reinforces their commitment to raising awareness about antibiotic resistance. This makes them active ambassadors for the cause, helping to spread the importance of the proper use of antibiotics.”

How we measure vaginal health

Recent research has uncovered a new layer of complexity in understanding the vaginal microbiome, revealing that its state is far from static. Traditionally, scientists have used the Nugent score (sidenote: Nugent score A diagnostic scoring system used to assess bacterial vaginosis based on the presence and proportions of certain bacteria in a Gram-stained vaginal sample. ) ² and Community State Types (CSTs) ³ to classify vaginal microbiomes.

The Nugent score assesses microbiome health through microscopy, calculating a score based on the abundance of bacterial morphotypes associated with either "healthy" or BV-associated microbiota. CSTs, meanwhile, classify vaginal microbiomes into five types based on bacterial dominance, indicating either Lactobacillus-dominated "eubiotic" states or diverse, Lactobacillus-poor states associated with dysbiosis. 

Mapping microbiome dynamics with VCDs

The recent study ¹ led by Dr. Ina Schuppe‑Koistinen and Prof. Henriette Svarre Nielsen from the Karolinska Institute observed daily microbiome transitions in 49 young women over a complete menstrual cycle, uncovering four distinct VCDs: constant eubiotic (stable Lactobacillus (sidenote: Lactobacillus A group of beneficial bacteria commonly found in the vaginal microbiome. They produce lactic acid, helping maintain a low pH to protect against infections. ) -dominant), constant dysbiotic (persistent dysbiosis), menses-related dysbiotic (Lactobacillus dominance disrupted only during menstruation), and unstable dysbiotic (frequent shifts in microbial composition).

These VCDs highlight each woman’s unique microbial stability or instability in response to external factors like menstruation and sexual activity - factors often overlooked by both CSTs and Nugent scoring.

Phages and bacteriocins: key players in vaginal microbiome stability

The study also found that bacteriophages and bacteriocins might influence microbiome dynamics. Higher phage activity was observed in unstable VCDs, suggesting a potential role in selectively reducing Lactobacillus populations. Additionally, certain strains of Gardnerella in dysbiotic VCDs contained bacteriocin genes, which may inhibit beneficial lactobacilli and contribute to microbiome instability. These insights could eventually lead to new therapies aimed at stabilizing the vaginal microbiome by targeting phages or bacteriocins.

Why VCDs could transform clinical practice

The shift from static to dynamic classification holds significant promise for clinical applications. While Nugent scores and CSTs can indicate "healthy" or "dysbiotic" states from single samples, VCDs offer insights into microbiome resilience, revealing how often an individual’s microbiome shifts toward dysbiosis. For instance, VCDs could enable clinicians to identify patients prone to frequent microbiome disruptions and help them design more targeted, preventive interventions.

Think your vaginal health is set in stone? Think again. Groundbreaking new research ¹ reveals that the vaginal microbiome - a dynamic community of bacteria unique to each woman - is constantly on the move, adapting daily to everything from hormone shifts to lifestyle habits, and even intimate moments.

These daily changes don’t just affect comfort; they have a lasting impact on overall health, making this discovery a game-changer for women looking to take control of their wellness in a truly personalized way.

Your microbiome’s four moods

For years, scientists relied on methods like the Nugent score (sidenote: Nugent score A diagnostic scoring system used to assess bacterial vaginosis based on the presence and proportions of certain bacteria in a Gram-stained vaginal sample. ) ³ and Community State Types (CSTs) ⁴ to assess vaginal health. The Nugent score looks at bacteria under a microscope, identifying an “imbalance” or bacterial vaginosis if there’s a lack of beneficial bacteria. CSTs, on the other hand, are like “snapshots” of the microbiome, grouping it into five main types based on a single sample.

However, researchers recently found that these single-time-point snapshots don’t tell the full story. A new method ¹ called Vaginal Community Dynamics (VCDs) digs deeper by tracking daily microbiome changes across a full menstrual cycle, uncovering how each woman’s microbiome responds to her unique internal and external environment.

So, what did they find?

Using daily samples from 49 women, the researchers uncovered four distinct “modes” or patterns of vaginal microbiome behavior:

• Constant Eubiotic: This mode is steady and resilient, dominated by beneficial Lactobacillus (sidenote: Lactobacillus A group of beneficial bacteria commonly found in the vaginal microbiome. They produce lactic acid, helping maintain a low pH to protect against infections. ) bacteria throughout the cycle. Women with this pattern have a balanced microbiome that doesn’t change much, even with external factors like menstruation or sexual activity.
• Constant Dysbiotic: In this mode, the microbiome remains imbalanced, lacking the typical Lactobacillus protection and often showing higher levels of bacteria linked to bacterial vaginosis. This can make it more susceptible to infection.
• Menses-Related Dysbiotic: Here, the microbiome shifts into an imbalanced state only during menstruation, but returns to normal afterward. Hormones and menstrual bleeding can affect pH and nutrient levels, leading to temporary changes in bacterial makeup.
• Unstable Dysbiotic: Women with this pattern experience frequent shifts between a balanced and imbalanced microbiome, often in response to events like menstruation or unprotected sex. This mode shows a microbiome that isn’t as resilient and can change quickly, increasing the risk of discomfort or infection.

Tips for supporting your vaginal microbiome

So how can you keep your microbiome balanced and healthy? Here are a few science-backed tips:

• Add probiotics: Look for probiotics with Lactobacillus strains or enjoy probiotic-rich foods like yogurt and kimchi.
• Use gentle hygiene: Stick to unscented soap and avoid douching to protect your microbiome’s balance.
• Choose period products wisely: Many women find unscented, organic tampons or silicone menstrual cups to be gentler.
• Eat a balanced diet: High-fiber, low-sugar diets support both gut and vaginal microbiomes.
• Practice safe sex: Condoms can help keep the vaginal microbiome stable by limiting new bacterial exposure.

Understanding the daily rhythms of your vaginal microbiome gives you the power to take control of your health in new ways. By tuning into these insights, you can make simple choices to support your body naturally and embrace wellness that’s truly in sync with you.

“One of the most serious threats to global health, food security, and development”.  This is how the WHO ² describes antibiotic resistance. Antimicrobial peptides (AMPs) (sidenote: Antimicrobial peptides (AMPs) Antimicrobial peptides (AMPs) are short sequences of amino acids widely present in a variety of organisms, including bacteria, plants, amphibians, insects, fish, and mammals. They are capable of disrupting microbial growth, most often by interfering with cell wall integrity. Explore https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/antim… ) are seen as a promising solution to the problem. However, they remain in short supply Some examples include:

• bacitracin produced by Bacillus licheniformis is used to treat eye and skin infections
• colistin produced by Paenibacillus polymyxa var. collistinus is used to treat pneumonia in cystic fibrosis patients
• polymyxin B produced by Paenibacillus polymyxa is used to treat topical infections

The study described below sought to identify new candidates, based on 1,773 genomes from the human microbiomes of the skin, mouth, gastrointestinal system, and vagina of 263 healthy women participating in the NIH Human Microbiome Project. ³

323 potential candidates

The team identified 323 potential candidates, which the authors called SEPs (smORF (sidenote: SmORF (Small open reading frames) Short sequences encoding small peptides of less than 100 amino acids capable of mediating key physiological functions in humans and animals. Explore Couso JP, Patraquim P. Classification and function of small open reading frames… ) -encoded peptides).

Of these, 78 were selected on the basis of three criteria (antimicrobial potential, diversity of families represented, and ease of synthesis). These were then synthesized and tested against:

• 11 clinically relevant pathogen strains (Acinetobacter baumannii, E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium)
• 13 of the most common commensal bacteria of the GI tract (belonging to four phyla: Verrucomicrobia, Bacteroidetes, Actinobacteria, et Firmicutes)

Unlike AMPs, SEPs can also target commensals.

70.5% show antimicrobial activity

In all, 55 of the 78 SEPs synthesized (70.5%) displayed in vitro antimicrobial activity against at least one pathogenic or commensal bacterium:

• 33 of the 78 SEPs destroyed at least one of the 11 pathogens tested; S. aureus was the only pathogen not targeted by any of the 78 SEPs synthesized;
• 45 of the 78 SEPs displayed mild antibacterial activity against commensals.

The five most promising SEPs (high activity against pathogens, limited or no activity against commensals) were encoded by skin and GI bacteria (sidenote: Skin and GI bacteria Faecalibacticin-3 (Faecalibacterium prausnitzii), fusobacticin-2 (Fusobacterium nucleatum), keratinobacin-1 (Keratinibaculum paraultunense), staphylococcin-2 (Staphylococcus capitis), and prevotellin-2 (Prevotella copri) ) . Les actions des différents SEP se révélaient souvent synergiques.

In vivo (murine model), the best candidate, prevotellin-2 (P. copri), proved to be as effective as the reference antibiotic (polymyxin B) in terms of reducing the bacterial load, with no noticeable toxicity for mice infected with A. baumannii.

Focus on the cytoplasmic membrane

To determine their mechanisms of action, antimicrobially active SEPs were studied from every angle. Their antimicrobial action seems to target the cytoplasmic membrane of the bacteria they depolarize (whereas conventional AMPs and EPs generally target the outer membrane).

A natural, non-toxic and ecologically responsible product that improves the equilibrium of the skin microbiota and helps fight against skin problems: you thought it was a dream? A team of Italian researchers has done it...using pomegranate skins that were about to be thrown away! ¹

This inedible part makes up 50% of the fruit. It usually ends up in the trash during the manufacture of pomegranate juice and extracts. However, it contains the majority of the precious polyphenols found in pomegranate, some of which possess antibacterial properties that are of interest for health.

The Italian researchers wanted to know whether, by making using of these peels to extract their precious components, it would be possible to develop a product capable of re-establishing the equilibrium of the skin microbiota and improving skin health.

The battle: good bacteria vs. bad bacteria

Dysbiosis of the skin microbiota, characterized by the proliferation of pathogenic bacteria to the detriment of beneficial bacteria, has been implicated in numerous skin problems, such as acne, psoriasis and atopic dermatitis.

The researchers first took samples of the skin microbiota from the skin of 9 young volunteers, 3 of whom suffered from skin problems linked to atopic dermatitis. From these samples, they extracted:

• Staphylococcus aureus, pathogenic bacteria responsible for skin dysbiosis
• Staphylococcus epidermidis, known for its beneficial effects and its ability to restore the integrity of the skin barrier.

Meanwhile, the scientists prepared an extract of pomegranate peel (Punica granatum L.) using energy-saving extraction methods and recyclable solvents. 

After verifying that it was non-toxic, they placed the product in contact with the bacteria taken from the volunteers.

Twofold effect of pomegranate

The result: the pomegranate extract has both a significant antimicrobial effect on the pathogenic S. aureus and a protective effect on the beneficial S. epidermidis. 

For the researchers, these effects are most likely connected to the phenolic components of pomegranate: catechins, quercetin, gallic acid, etc. These act in a targeted manner, on the one hand preventing pathogenic bacteria from sticking to the skin and forming protective biofilms, and on the other hand stimulating the ability of beneficial bacteria to synthesize biofilms. 

Clinical trials will need to be carried out before it is possible to confirm the ability of this extract to prevent, alleviate or cure skin problems, particularly those linked to antimicrobial-resistant bacteria. 

If the results are positive, this would provide further evidence that it is possible to integrate the health of the ecosystem with human health using a “One health” ² approach.

The risk of so-called fragility fractures (sidenote: Fragility fractures Fragility fractures result from low-energy trauma (a mechanical force that would not ordinarily cause a fracture), such as a fall from standing height or less. These fractures are the main clinical consequence of osteoporosis, although they may occur in postmenopausal women even in the absence of osteoporosis.  ) (i.e. with no major trauma), largely linked to osteoporosis, increases with age, with one in two women and one in four men suffering an osteoporotic fracture at some point: fracture of the femoral neck after a very light fall, broken wrist as a result of minor trauma, vertebral compression, etc.

Bone is constantly remodeling itself and tends to be destroyed faster than it can be rebuilt after the age of 45. In addition to traditional bone protection methods such as a healthy diet and physical exercise, a new avenue is opening up: the gut microbiota, already implicated in bone health and the risk of osteoporosis. A new study has shown that our gut flora predicts the risk of ending up in a cast.

Gut bacteria: friend or enemy of our bones?

A healthy gut microbiota rests on a wide variety of gut bacteria. This diversity also has consequences for bone strength, say researchers who analyzed the microbiota of over 7,000 Finns. The verdict: the more diverse the microbiota, the lower the risk of fracture.

How can this link be explained? Among the many bacteria that colonize our gut, some have a beneficial effect, while others weaken our bones. Proteobacteria, already implicated in various types of inflammatory bowel disease and irritable bowel syndrome, may also promote more generalized inflammation in the body, and with it bone fragility.

Conversely, Tenericutes produce tiny fatty acids, including butyrate, which have a protective anti-inflammatory effect.

A balanced microbiota for strong bones?

The future of fragility fracture prevention may thus be a question of rebalancing your gut flora. In addition to an adequate intake of calcium and vitamin D, for healthy bones, take care of your “good” bacteria.

Despite these promising results, considerable work is still required to confirm a causal relationship between bacteria and fractures, and to understand how gut bacteria act to protect or weaken bones. In the meantime, for strong bones into old age, make sure to mind your gut.

The increase in the number of bone fractures associated with an aging population represents a major public health concern, with one in two women and one in four men expected to suffer an osteoporotic fracture at some point. These fragility fractures most often result from a loss of bone mass that is difficult to prevent. Previous studies have shown a link between gut microbiota and bone mass in mice and humans. A new study has revealed that the gut microbiota also influences the risk of fragility fractures.

Microbiota composition, an indicator of fracture risk

The researchers used data from the FINRISK ² cohort, which followed 7,043 Finnish subjects over 18 years. Metagenomic sequencing of the participants’ gut bacteria revealed that greater alpha diversity (sidenote: Alpha diversity Number of species coexisting in a given environment )  in the gut microbiota is associated with a reduced risk of fracture.

Could inflammation be the key?

As regards the mechanisms, a number of metabolic pathways have been implicated. Proteobacteria were associated with a reduced synthesis of branched-chain amino acids, which are known to be associated with bone health, and an increased production of pro-inflammatory microbial lipopolysaccharides. Tenericutes, on the other hand, are associated with the biosynthesis of anti-inflammatory short-chain fatty acids (sidenote: Short chain fatty acids (SCFA) Short chain fatty acids (SCFA) are a source of energy (fuel) for an individual’s cells. They interact with the immune system and are involved in communication between the intestine and the brain. Silva YP, Bernardi A, Frozza RL. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front Endocrinol (Lausanne). 2020;11:25. )  (SCFA) such as butyrate. Proteobacteria and Tenericutes may therefore modulate inflammation, and with it bone resorption.

Towards new fracture prevention strategies?

Although these results are promising, they are based on correlative analyses in a large but not very diverse population (Northern Europeans), and only on the predominant phyla of the gut microbiota (at the risk of overlooking the effect of rare phyla). Further research is therefore needed to establish a causal relationship between microbiota and fracture risk, and to understand the underlying mechanisms.