Date of Award

Spring 2022

Document Type

Open Access Dissertation


Environmental Health Sciences

First Advisor

Sean Norman


The role of antibiotics in human health is of significant importance in the advancement of the medical field. It has contributed to an improvement of the quality of life and the age expectancy of the population. Antibiotic resistance is an expected consequence of the use of antibiotics. Bacteria have developed biological mechanisms that would help them become resistant to antibiotics. The uncontrolled use of antibiotics is significantly contributing to the ability of bacteria to become resistant to those antibiotics. This study, using the model of the Socio-Ecological Coupling of Antibiotic Resistance, explains how social and environmental factors interact and impact the social and natural cycle of antibiotic resistance. Using spatial analysis, the study describes how antibiotic sales in combination with other demographic factors contribute to the appearance of antibiotic sales hot spots. The expectation of antibiotic resistance in these hot spots is higher and the urgency for intervention with antibiotic stewardship programs at the community level is necessary. Experimentally, the study demonstrates how wastewater treatment plants, being the receptacle for most antibiotics consumed, can become a source of exposure to antibiotic resistant genes through bioaerosols. Lastly, using epidemiological methods, the study describes temporal trends of antibiotic sales and how these can be used as an indicator for population health.


© 2022, Andrés Gaviria-Figueroa