Epidemiological profile and clinical outcomes of patients with mucormycosis: the multicenter retromucor study from Turkiye (2004-2024)

Abstract

Purpose Mucormycosis is a rapidly progressive angioinvasive fungal infection with limited large-scale outcome data. We aimed to describe the epidemiology, clinical spectrum, treatment strategies, and predictors of outcomes in adult patients with proven mucormycosis in T & uuml;rkiye. Methods We conducted a nationwide, retrospective study of 280 adults diagnosed with proven mucormycosis between 2004 and 2024 across 27 tertiary centers. Case definitions were applied according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clinical characteristics, antifungal management, surgical interventions, and outcomes were systematically analyzed. Results The median age of the cohort was 60 years, and diabetes mellitus, frequently complicated by ketoacidosis, was the most common underlying condition. Rhino-orbital-cerebral disease represented the predominant clinical form, whereas pulmonary, gastrointestinal, and disseminated presentations were less frequent but carried less favorable prognoses. Liposomal amphotericin B was the main first-line therapy, often combined with surgery, although antifungal treatment was initiated at a median of five days after symptom onset. Ninety-day mortality was 42.1% by Kaplan-Meier estimation (crude 49.3%) and reached 49.3% (crude 55.0%) at 365 days. Crude mortality was lowest in patients who did not undergo surgery; however, this association was not significant in the time-dependent Cox regression analysis, suggesting confounding by baseline severity. Poor outcomes were associated with corticosteroid exposure, prolonged neutropenia, and neurological manifestations, while a history of sinusitis appeared to be associated with improved survival. Conclusion In this multicenter study, survival was mainly determined by host-related factors rather than the choice of antifungal agent. Corticosteroid exposure, prolonged neutropenia, and neurological involvement independently predicted poor outcomes, whereas a prior history of sinusitis was linked to improved survival, likely reflecting earlier diagnosis and intervention. These findings reinforce the need for heightened clinical awareness, rapid recognition, and prompt multidisciplinary management to improve outcomes in patients with mucormycosis.