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Background and Importance Surgical antibiotic prophylaxis (SAP) plays a crucial role in preventing surgical site infections (SSIs), but deviations from guidelines remain common. Continuous monitoring of prophylactic practices is essential within Antimicrobial Stewardship (AMS) programmes to promote rational antibiotic use and reduce resistance selection.Aim and Objectives To evaluate the appropriateness of SAP in two surgical units of a teaching hospital, identify the main deviations from current guidelines, and provide evidence to support targeted AMS interventions.Material and Methods A Point Prevalence Survey (PPS) was conducted as part of a single-centre cross-sectional study. Data were collected from adult patients undergoing surgery in the Cardiac Surgery Unit (CSU) and the General Surgery Unit (GSU). SAP appropriateness was assessed by a multidisciplinary team based on six predefined indicators (indication, antibiotic selection, dosage, preoperative timing, intraoperative redosing, postoperative duration), following official guidelines. Associations with postoperative outcomes (SSI, healthcare-associated infections - HAI, length of stay) were analysed.Results A total of 93 patients were included (CSU=51; GSU=42). Overall, full adherence to the six indicators was 35.5% (CSU 52.9%, GSU 14.3%; p<0.001). The indication for prophylaxis was appropriate in 96.8% of patients, and antibiotic selection in 81.6%, with cefazolin being the most commonly used agent. Dosage was appropriate in 84.9% of patients, preoperative timing in 59.3%, intraoperative redosing in 42.9%, and postoperative duration in 90.7%. Significant differences emerged between the two units, with higher adherence rates observed in the CSU. After adjustment for surgical unit and ASA score, full appropriateness was associated with lower SSI rates (OR: 0.22, 95% CI 0.01–1.03), lower HAI rates (OR: 0.72, 95% CI 0.43–1.22), and shorter hospital stays (β = -1.1 days, 95% CI -3.0 to -0.8).Conclusion and Relevance Full adherence to SAP guidelines was low but associated with improved clinical outcomes. Although antibiotic selection and dosing were largely appropriate, preoperative timing and intraoperative redosing remained critical areas for improvement. The PPS proved to be an effective tool not only for monitoring SAP appropriateness, but also for guiding targeted improvement strategies. Implementation of standardised protocols, real-time auditing, and AMS-driven educational initiatives may foster a progressive enhancement of adherence over time.Conflict of Interest No conflict of interest