Prevalence and antimicrobial resistance patterns of Escherichia coli isolates from humans and animals in Ethiopia: a systematic review and meta-analysis

Escherichia coli (E. coli), a common member of the Enterobacteriaceae family, is a significant pathogen with increasing antimicrobial resistance (AMR), threatening both human and animal health. Despite its public health importance, data on its prevalence and resistance patterns in Ethiopia are scarce. The national AMR surveillance system is fragmented, with gaps in standardized monitoring and reporting. This systematic review and meta-analysis aimed to synthesize the prevalence and AMR patterns of E. coli isolates from human and animal sources in Ethiopia. Of 1,707 articles screened, 15 studies met the inclusion criteria. The pooled prevalence of E. coli was 28.8% (95% CI: 18.37–39.30, I² = 99.1% & p < 0.001). Begg’s and Egger’s tests were also used to look for publication bias. Antimicrobial resistance in humans was 55.5% (95% CI: 48.4–62.6), in animals 40.3% (95% CI: 28.8–51.8), and in combined sources 40.3% (95% CI: 25.50–55.20). High resistance was observed to piperacillin (92.3%), erythromycin (92.9%), and clindamycin (100%), although these extreme values should be interpreted cautiously due to potential methodological biases in antimicrobial susceptibility testing. Multidrug resistance was 80.7% among humans, 50.0% animals, and 76.0% combined isolates. Of 1,707 articles screened, 15 studies met the inclusion criteria. The pooled prevalence of E. coli was 28.8% (95% CI: 18.37–39.30, I2 = 99.1% & p < 0.001). Additionally, Begg’s and Egger’s tests were performed to assess publication bias. Antimicrobial resistance in humans was 55.5% (95% CI: 48.4–62.6), in animals 40.3% (95% CI: 28.8–51.8), and in combined sources 40.3% (95% CI: 25.50–55.20). High resistance was observed to piperacillin (92.3%), Erythromycin (92.9%), and clindamycin (100%), although these extreme values should be interpreted cautiously due to potential methodological biases in antimicrobial susceptibility testing. Multidrug resistance was observed in 80.7% of humans, 50.0% among animals, and 76.0% among combined isolates. Likely drivers include improper antibiotic use, food chain contamination, and limited surveillance. This systematic review and meta-analysis displayed a substantial prevalence of E. coli and alarming antimicrobial and multidrug resistance in human and animal source samples in Ethiopia. The findings signal an urgent need for coordinated public health and veterinary interventions. Strengthening national antibiotic stewardship programs, expanding AMR surveillance networks, and promoting hygiene, sanitation, and rational drug use are crucial. Implementing these measures within a One Health perspective is vital to protect both human and animal health and to mitigate the growing AMR burden sustainably.