Introduction: Particularly in low- and middle-income countries (LMICs), surgical site infections (SSIs) account for a major source of morbidity and rising healthcare costs. These infections might seriously affect patient outcomes and hinder recovery. The aim of this study was to investigate the antibiotic resistance patterns at a tertiary care hospital in Pakistan, assess the frequency of SSIs, and pinpoint related risk factors. Methodology: From August 2023 to July 2024 Fauji Foundation Hospital Peshawar Cantt conducted a cross-sectional study. The study comprised 86 patients having different surgical treatments. Retroactive data collecting from patient records concentrated on demographics, kind of surgery, length, and use of prophylactic antibiotics. By means of microbiological testing, pathogens generating SSIs were identified; their antibiotic resistance profiles were investigated. Significant risk variables linked with SSIs were found using statistical analyses including logistic regression and chi-square testing. Results: The study determined a general SSI prevalence of 22.1%. Advanced age (≥50 years), emergency surgery, longer surgical length (more than two hours), diabetes mellitus, and lack of prophylactic antibiotic treatment constituted major risk factors. Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were the most often separately isolated pathogens. Especially, antibiotic resistance was rather common, and among the infections there were found multidrug-resistant organisms. Conclusion: The results show concerning degrees of antimicrobial resistance in the investigated environment and a high frequency of SSIs. These findings highlight the necessity of better infection control policies, better antibiotic stewardship, and focused approaches to handle SSIs and resistance in LMICs so enhancing patient outcomes and healthcare quality.