Surgical Antibiotic Prophylaxis Utilization and Predictors of Surgical Site Infections at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia: Prospective Cohort Study

Background Surgical site infections (SSIs) are a major postoperative complication, particularly in resource‐limited settings such as Ethiopia. Despite evidence‐based guidelines, inappropriate surgical antibiotic prophylaxis (SAP) remains common. This study is aimed at assessing SAP utilization patterns, SSI prevalence, and associated factors at Debre Tabor Comprehensive Specialized Hospital. Methods A prospective cohort study was conducted among 342 surgical patients from February 1 to May 30, 2025. Adherence of SAP was assessed based on standard national and international guidelines. Descriptive, bivariate, and multivariable analyses were conducted using IBM SPSS software Version 27. Statistical significance was set at p < 0.05. Results Preoperative prophylaxis was administered to 69.3% of patients, although 83.1% received inappropriate antibiotics. Ceftriaxone (50.2%) and its combination with metronidazole (27.4%) were the most commonly used antibiotics. The overall magnitude of SSI was 10.8% (95% CI: 7.5–14.1). Elective surgery (AOR = 0.57), absence of comorbidities (AOR = 0.13), and appropriate SAP use (AOR = 0.67) were associated with reduced odds of developing SSI. In contrast, procedures lasting 2–3 h (AOR = 4.21) or more than 3 h (AOR = 5.26), contaminated (AOR = 3.42) or dirty wounds (AOR = 9.35), antibiotic prophylaxis administered more than 1–2 h before incision (AOR = 5.34), and postoperative SAP duration exceeding 72 h (AOR = 5.63) were linked to an increased risk of SSIs. Conclusion SSIs are still a significant burden at Debre Tabor Comprehensive Specialized Hospital. Strengthening adherence to SAP guidelines is essential to reduce infections and improve patient outcomes.