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Clinical profiling, antifungal drug susceptibility, and biofilm formation ability in pulmonary mucormycosis

Summary

This study examined 26 patients with a serious lung fungal infection called mucormycosis in a Beijing hospital. Most patients were older with health problems like diabetes and high blood pressure, and sadly about 4 in 10 died. Interestingly, most patients had other infections (viral or fungal) before developing mucormycosis. The researchers tested which antifungal drugs worked best against the fungus, finding that amphotericin B was most effective, though it can damage kidneys. They also discovered that most of the fungal strains could form protective biofilm structures, making treatment more difficult.

Background

Pulmonary mucormycosis (PM) is a life-threatening invasive fungal infection caused by Mucorales with high mortality rates exceeding 50%. The disease has shown increased incidence in recent decades, with the COVID-19 pandemic contributing to unprecedented case surges. Comprehensive data integrating clinical profiling, antifungal susceptibility, and biofilm formation in PM are limited.

Objective

This study aimed to characterize 26 adult PM patients at a Beijing tertiary-care hospital by describing demographic and clinical characteristics, determining in vitro antifungal susceptibility profiles against nine agents, and investigating biofilm formation ability of clinical Mucorales isolates.

Results

Among 26 PM patients, median age was 66 years (65.4% male) with 92.3% comorbidity burden and 38.5% in-hospital mortality. Strikingly, 80.8% had co-infections, with viral (77.8%) and fungal (62.5%) co-infections often preceding Mucorales detection. Rhizopus spp. predominated (54%), followed by Rhizomucor (19%), Mucor (19%), and Lichtheimia (8%). Amphotericin B showed most consistent activity (MIC50/MIC90: 1/2 µg/mL), while posaconazole was most potent azole (MIC50/MIC90: 0.25/1 µg/mL). Biofilm formation at 48h peak occurred in 84.6% of isolates with genus-level heterogeneity.

Conclusion

This comprehensive characterization underscores PM severity and complexity, highlighting high comorbidity burden, substantial mortality, and remarkable co-infection prevalence often preceding Mucorales detection. Species-level identification and susceptibility testing revealed profound genus-level heterogeneity in antifungal response and biofilm formation ability. These findings emphasize the imperative of species-level identification, susceptibility testing, and consideration of genus-specific traits for effective PM management.
  • Published in:BMC Microbiology,
  • Study Type:Retrospective Clinical Study,
  • Source: 10.1186/s12866-025-04472-9, PMID: 41188718
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