Typhoid fever, which is caused by the gram-negative bacterium Salmonella typhi, is still a significant public health issue on a global scale. It is a major source of food-borne disease worldwide, and the spread of antimicrobial-resistant strains is becoming a rising concern. Travel to endemic areas, poor hygiene habits, poor sanitation conditions, proximity to flying insects feeding on faeces, contact with someone who recently suffered from typhoid fever, recent use of antibiotics, immunosuppressive illnesses, crowded housing, consumption of raw fruits and vegetables contaminated with sewage, are all risk factors for typhoid fever. The primary goal of this study was to determine the prevalence of typhoid fever, antimicrobial resistance patterns and associated risk factors among febrile patients at Felege Hiwot comprehensive specialized referral hospital from January to March 2023. A cross-sectional study was carried out on 403 febrile patients who were selected using systematic random sample techniques. Face-to-face interviews with pretested structured questionnaires were used to collect data. Stool specimens were collected, cultured, and biochemical and antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method with the assistance of two competent laboratory workers. SPSS version 25 was used to enter and analyse the data. Binary logistic regression was done to determine the strength of association between dependent variables and possible risk factors. Variables with a p value of less than 0.25 during Univariate logistic regression analysis were selected for multivariate analysis. A p-value of less than 0.05 was used to indicate statistical significance. The overall prevalence of typhoid fever was 4.5% (18/403). Factors like eating raw vegetable and fruits [AOR =9.88; 95% CI: (1.285–75.990, p = 0.028)]; eating street food [AOR =8.57; 95% CI: (1.279–57.398, p = 0.027)], and drinking raw milk [AOR =7.58; 95% CI: (1.102–52.207, p = 0.040)] were statistically significant associated with the occurrence of typhoid fever. The majority of Salmonella typhi isolates were responsive to Ciprofloxacin but resistant to Ampicillin and Cotrimoxazole. Based on these findings, not drinking raw milk improving sanitation and hygiene practices, and limiting intake of microbially contaminated food can help lower the occurrence of typhoid fever. Keywords: - typhoid fever, Salmonella typhi, antimicrobial resistance patterns, associated risk factors, prevalence,