Expert Spotlight: Peter Collignon

Peter Collignon, M.D., a prominent antibiotic resistance expert and infectious diseases physician and microbiologist at Canberra Hospital in Australia, served as a visiting scholar with us from May to July 2016. During his tenure he studied the issue of antibiotic resistance with a particular focus on the connection between drug use in food-animal production and antibiotic-resistant human infections. Below Dr. Collignon answers some pressing questions on antibiotic resistance and the role everyone has to play in combating this global threat.

And below are a few additional questions answered by Dr. Collignon!

Antibiotic resistance is a global problem that affects everyone. What role can consumers, media, industry and policymakers play in tackling antibiotic resistance?

Antibiotic-resistant bacteria cause serious infections – potentially in all of us. We need to change locally and globally what we do and limit their impact on us, our families and in the broader community. We need to decrease the tons and tons of antibiotics used in people and animals and stop superbugs from spreading.

This means we all need to keep as healthy as possible so we don’t get infections and then don’t need to take antibiotics. It means good hygiene and infection control so we have less contact with superbugs and so we don’t pass them on to others. It means keeping superbugs out of the foods we eat and water we drink.

We as consumers can use our buying power to support those companies that are now better controlling the problem. We can use our influence as voters on politicians to help move our countries in a better direction.

The media is vital to get the message out and inform consumers. It’s the media along with consumers that most influence industry and policy makers to better address the two fundamental drivers of superbugs – the excessive tons of antibiotic used in people and animals plus better ways to stop their spread (via people, food and water).

What should the European Union, World Health Organization and countries around the world do to truly address the global public health threat of antibiotic resistance?

We need policies and laws that stop superbugs from needlessly developing and then spreading. All countries need to have practices in place that decrease and limit the use of all antibiotics. This is especially important for “last-line” or “critically important” antibiotics. We should not be using “critically important” antibiotics in food animals, especially as mass medication to very large groups of animals.

We need countries everywhere to stop the spread of superbugs. Clean water for all around the world is essential. So is ensuring that we don’t send these superbugs around the world with our global food trade.

We need to stop people and animals getting sick by preventative health programs that include effective vaccines, good nutrition plus good housing, etc.

Colistin resistance and the mcr-1 mobile gene are getting a lot of attention these days. Can you explain what this is and what should be done to address this scary new reality? Is there a connection to antibiotic use in food animal production?

Colistin is an effective (but toxic) antibiotic against many multi-resistant superbugs such as some strains of E.coli and Klebsiella. It is now often all we have left that still works. If superbugs are resistant to colistin there can be nothing left to treat people with life threatening infections such as those in the bloodstream.

Colistin has been and is used widely in many countries (e.g. China and most European Union countries) as a routine preventative antibiotic given to food animals in very large herds/flocks. This use, not surprisingly, causes resistant superbugs to develop. Then these resistant bacteria multiply and spread to other animals, from farm to farm and then to people via contaminated foods or in water that runs off from farms using colistin. People ingest these bacteria and if they then get to a place that’s bad for us (e.g. our urinary tract, blood etc.) then we can become very sick but without any antibiotic that can cure us.  

Are there lessons from Australia or other countries that the United States should consider adopting to address antibiotic resistance? Conversely, what can the U.S. share with the rest of the world?

Australia never allowed a "critically important" antibiotic class of antibiotics called fluoroquinolones (e.g. ciprofloxacin or cipro) to be used in food animals. This did not cause any economic loss to meat production in Australia. We have almost no ciprofloxacin resistant E.coli, Salmonella or Campylobacter bacteria in food animals or foods in Australia – in contrast to almost all other countries where fluoroquinolones have been used in food animals. Australian citizens have very low rates of fluoroquinolone-resistant superbugs despite these drugs being used in people for over 30 years. It shows what we do in food animals has an effect on the numbers and types of superbugs that can infect people.

In a number of countries (e.g. Canada) it’s been shown that if you don’t allow 3rd generation cephalosporins to be used in poultry, you have less cephalosporin-resistant superbugs causing infections in people.

The U.S. has a number of poultry producers that have led the way to stop the unnecessary use of antibiotics in food animals. Many others are now following this lead. The U.S. also has major retail groups that have put in place policies that limit and/or stop antibiotics being used in some of the meat and poultry they purchase. Because the U.S. is the world’s economic leader, these marketplace changes have effects globally.

Many countries and regions have policies that are controlling superbugs - Australia's fluoroquinolone ban, The Netherlands with a recent 70 percent reduction in antibiotic use in food animals, and the EU with its decades-long ban on antibiotics as growth promoters. The major problem is that no country or region does all these things together. Superbugs move around the world in planes and boats. They don’t respect borders. We all need to work together more effectively and put in place much tighter rules than what we have currently.