Educational gaps in antimicrobial stewardship among Tunisian medical residents: a multicenter cross-sectional study

Abstract Background Antimicrobial resistance (AMR) is a major global public health threat driven in part by inappropriate antibiotic prescribing. Medical residents play a central role in antimicrobial prescribing and represent an important target for antimicrobial stewardship (AMS) interventions. This study aimed to assess the knowledge, perceptions, attitudes, and self-reported practices related to antimicrobial prescribing and AMR among Tunisian medical residents. Methods We conducted a multicenter cross-sectional survey between June and December 2022 among medical residents practicing in three tertiary teaching hospitals in central Tunisia. A self-administered questionnaire adapted from previously published instruments assessed sociodemographic characteristics, antimicrobial prescribing knowledge, perceptions of factors influencing prescribing and AMR, and self-reported prescribing practices. Descriptive statistics were used to summarize the findings. Results A total of 337 medical residents participated, representing 48.4% of eligible residents. Most respondents were enrolled in medical specialties (68.5%), while only 27.0% had received antimicrobial prescribing training during the previous year. Knowledge gaps were identified in several key areas. Although most residents correctly recognized that antibiotics were not indicated for acute diarrhea (83.7%), only 52.2% appropriately rejected antibiotic use for upper respiratory tract infections. Less than half correctly identified antimicrobial dose adjustment requirements in severe renal impairment (40.0%), and 49.6% incorrectly considered methicillin-resistant Staphylococcus aureus susceptible to cephalosporins. Most participants perceived AMR as a major problem nationally (97.7%) and within their institutions (89.6%). Guideline availability (87.6%), colleagues’ opinions (95.8%), infectious disease specialists (90.5%), and senior physicians (84.6%) were identified as major influences on prescribing decisions. More than one-third of residents (35.9%) reported prescribing antibiotics to more than one patient daily. Conclusion Tunisian medical residents demonstrated substantial awareness of AMR but exhibited important deficiencies in antimicrobial prescribing knowledge and limited exposure to formal AMS training. These findings highlight the need to strengthen antimicrobial stewardship education during residency, improve access to locally adapted prescribing guidelines, and promote multidisciplinary stewardship support to optimize antibiotic use and combat AMR in Tunisia.