The fisheries and aquaculture sectors are growing rapidly, reflecting their importance in meeting the ever-increasing human population’s demands for animal protein. Production progress in this sector, however, is challenging as a result of increased deaths from epidemics caused by bacterial infectious diseases in aquaculturally important species. In order to minimize the impact of such diseases, quick and reliable diagnosis of pathogens, timely intervention, and control of the disease are essential to ensure the health of aquaculture and fisheries stocks. Thus, high-throughput proteomics-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been used as a rapid, accurate, and species-specific tool for the identification of bacterial fish pathogens and antibiotic resistance. The aim of this article is to review and evaluate the results of nearly three hundred papers published from 2010 to 2023 on the application of MALDI-TOF MS in aquaculture, showing that this method has been increasingly used over the years for the species-level identification and antibiotic resistance of fifty different gram-positive and negative bacterial aquatic pathogens encountered in wild or cultured fish, shellfish, invertebrates, and crustaceans. In addition, the history and general principles of the MALDI-TOF MS method are also mentioned in the article so that fish disease researchers interested in the use of this technology can see all aspects of the topic.