Lessons learned in the wake of the COVID-19 pandemic could help limit antibiotic-resistant bacterial infections that cost the U.S. an estimated $4.6 billion to treat.

That’s the message from researchers at the U.S. Centers for Disease Control and Prevention and the University of Utah who completed one of the the largest studies ever conducted on the economic burden of antibiotic resistance.

The study reviewed costs in 2017 for infections caused by six multidrug-resistant pathogens most frequently found in healthcare settings. It followed a 2019 report by the CDC that 2.8 million people get an antibiotic-resistant infection yearly, and more than 35,000 die. The early response to COVID-19 convinced the researchers that a robust and well-resourced infrastructure was needed to change the dynamic.

“COVID-19 has highlighted some of the weaknesses in our health-care system in how well we are able to prevent the acquisition of pathogens — whether it be COVID-19 or an antibiotic-resistant pathogen,” said John Jernigan, a CDC director and study co-author.

A main lesson from the pandemic, he said, is the need to boost investment for “infectious control, prevention and training, as well as surveillance and support for public health.”

The report also follows a study by the antibiotic resistance project for the Pew Charitable Trusts that looked at the link between COVID-19 and the misuse of antibiotics. That research, released this week found that more than half of hospitalized COVID patients got antibiotics in the first 48 hours of hospitalization early in the pandemic, even though it takes at least 48 hours to confirm an infection.

Rachel Zetts, an officer at the Trust, said that having antibiotic stewardship programs — an initiative that tracks and promotes the appropriate use of antibiotics — can help ensure that physicians can access real-time data for novel pathogens.

Physicians are “just trying to get the patients the best treatment possible,” Zetts said by phone. “Seeing this increase in antibiotic use is not entirely unexpected because of the concerns around bacterial infections as well as the difficulties in differentiating COVID pneumonia from bacterial pneumonia early on.”

We’ve also seen what happens when resources are stretched thin during a public-health emergency over the past year. During the height of the pandemic, we saw hospitals running short on masks, gowns, and PPE. The resources used for the antibiotic stewardship programs were depleted when personnel had to manage the COVID response, said David Hyun, who directs Pew’s antibiotic resistance project.

“All of these things raise the risk of spread of antibiotic resistance,” he said.