Prevalence and antimicrobial resistance profiles of bacteria isolated from fish in Ethiopia: a systematic review and meta-analysis

Background Contamination of fish by bacteria and the development of antimicrobial resistance (AMR) are important public health risks and a food safety challenge. Although fish is an important source of protein in Ethiopia, the pooled prevalence of fish-borne pathogens and the associated multidrug resistance (MDR) is not well quantified at the national level. The aim of this study was to estimate the pooled prevalence of bacteria isolated from fish in Ethiopia and to assess their AMR and MDR status. Methods Electronic databases (PubMed, Web of Science, African Journals Online, ScienceDirect, and CAB Abstracts) and other sources (Google Scholar and institutional repositories) were systematically screened for relevant studies published in Ethiopia. A random-effects model was used to estimate the pooled prevalence of bacteria and resistance profiles with 95% confidence intervals (CIs). The I2 statistic was used to assess heterogeneity. Subgroup analysis was conducted based on sampling site, publication year, sample size, fish species, study region, detection method, bacterial type and sampling method. Results Nine studies involving 1,805 fish samples were included. The pooled prevalence of bacteria isolated from fish was 28.28% (95% CI: 16.16, 40.41). Subgroup analysis by sampling site revealed the highest prevalence in studies in which both water bodies and retail shops were sampled (40.11%), whereas analysis by bacterial type revealed Aeromonas hydrophila (60.45%) and multiple pathogens (46.18%) as dominant threats (p < 0.001). Combined culture and molecular methods detected a higher prevalence (49.70%) than did culture alone. The overall pooled prevalence of AMR was 90.37% (95% CI: 79.76, 100.00); universal resistance (100%) was common for ampicillin, penicillin, and amoxicillin. The pooled MDR prevalence was 67.82% (95% CI: 30.30, 100.00). Significant statistical heterogeneity (I2 > 98%) was observed in all key outcomes. Conclusion The review shows that Ethiopian fish are significantly contaminated with bacteria exhibiting alarming multidrug resistance. Aeromonas species are dominant, and high levels of fecal indicators (Salmonella and E. coli) point to severe environmental pollution and poor postharvest hygiene. The presence of superbugs in the aquatic food chain is a serious health threat. The importance of One Health interventions should be emphasized in public health strategies, focusing on better sanitation at landing sites and strict control over the use of antimicrobials in aquaculture and livestock. Protocol registration This systematic review and meta-analysis study has been registered with the registration number CRD420260519149.