OBJECTIVE To systematically evaluate the clinical characteristics, diagnostic method accuracy and treatment regimen efficacy of Mycobacterium marinum infection worldwide, thereby providing evidence-based references for clinical diagnosis and treatment.

METHODS Clinical studies related to M. marinum infection, published between May 2000 and Dec. 2024, were identified by searching databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure （CNKI） and Wanfang. A meta-analysis was performed using Stata 17.0 software to assess the clinical characteristics, diagnostic method accuracy and the efficacy and safety of different treatment regimens for M. marinum infection.

RESULTS A total of 42 studies （1 896 patients） were included in this study. The results showed that M. marinum infection predominantly occurred in young and middle-aged individuals （weighted mean age: 38.60 years）, with skin and soft tissue infections being the primary type （82.30%） and 76.48% of patients having a definite history of water exposure. For diagnostic methods, nucleic acid testing demonstrated higher sensitivity （89.73%） than traditional culture （72.16%）, making it suitable for rapid diagnosis. For treatment, no statistically significant difference was observed in cure rates between the rifampicin-plus-ethambutol regimen and the clarithromycin-containing regimen （OR=1.150, 95%CI: 0.870−1.520, P=0.320）. However, both were superior to monotherapy （both P＜0.05）. The incidence of adverse reactions was 9.30% （95%CI: 6.50%−12.10%） for the rifampicin-plus-ethambutol regimen, 15.60% （95%CI: 12.30%−18.90%） for the clarithromycin-containing regimen and 8.70% （95%CI: 5.30%−12.10%） for monotherapy. A funnel plot was drawn according to the "cure rate of rifampicin-plus-ethambutol regimen", showing that the funnel plot was basically symmetrical. Egger's test indicated P=0.250, suggesting no significant publication bias.

CONCLUSIONS A history of water exposure is an important clue for M. marinum infection. Nucleic acid testing can improve diagnostic accuracy, and rifampicin-plus-ethambutol regimen can be considered as one of the preferred treatment options.