Prevalence, and Antimicrobial Resistance Profile of Escherichia coli O157:H7 Isolated from Human, Animal, and Environmental Samples in Ethiopia: A Systematic Review and Meta-Analysis
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Background Escherichia coli O157 is an important foodborne zoonotic pathogen with consequences for human and animal health and food safety. Its circulation at the human–animal–environment interface, together with antimicrobial resistance, makes it an important One Health concern. However, evidence on the burden and antimicrobial resistance of E. coli O157 across these interconnected sources in Ethiopia remains fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of E. coli O157 and characterize its antimicrobial resistance patterns from a One Health perspective. Methods PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched for cross-sectional studies published between January 2015 and May 2025. Two groups of reviewers independently screened studies using predefined eligibility criteria. Study quality was assessed using the Joanna Briggs Institute tool. Pooled prevalence and antimicrobial resistance proportions were estimated using random-effects models. Heterogeneity and publication bias were assessed, and sensitivity analysis was performed. Results A total of 1,224 records were identified, of which 52 studies were included in the meta-analysis. The overall pooled prevalence of E. coli O157 was 4.65% (95% CI: 3.58–6.02%), with substantial heterogeneity across studies. Prevalence varied by sample source, ranging from 3.21% (95% CI: 2.08–4.96%) in environmental samples to 7.65% (95% CI: 3.80–15.42%) in human samples. Antimicrobial resistance also varied considerably across agents, with the highest resistance observed for erythromycin (89.65%; 95% CI: 66.31–97.45%) and the lowest for ciprofloxacin (8.44%; 95% CI: 4.42–15.52%). Conclusion E. coli O157 remains an important One Health concern in Ethiopia, with evidence of circulation across human, animal, and environmental sources and substantial variation in antimicrobial resistance. These findings underscore the need for integrated One Health surveillance, strengthened antimicrobial stewardship, and coordinated interventions across human health, animal production, food safety, and environmental sectors. This review was registered in PROSPERO (CRD420251163665) and received no external funding.
