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Molecular epidemiology, diversity, and antifungal susceptibility profiles of clinical and environmental mucorales: a five-year multicenter study in Iran (2018–2023)

Summary

This study examined dangerous mold infections called mucormycosis that became more common during the COVID-19 pandemic, particularly in Iran. Researchers tested over 180 fungal samples from patients and soil to understand which types of molds cause infections and which antifungal medicines work best against them. They found that two medicines, amphotericin B and posaconazole, were most effective, while fungi from soil samples were often more resistant to treatment than those from infected patients. This research helps doctors choose the right treatments for patients with these serious infections.

Background

Mucormycosis is a rare but severe opportunistic fungal infection that has increased in incidence globally, particularly following the COVID-19 pandemic. The disease presents significant clinical challenges due to pathogen resistance to many antifungal drugs and high mortality rates, especially in immunocompromised patients.

Objective

This study aimed to molecularly identify Mucorales isolates from clinical and environmental sources across Iran and evaluate their antifungal susceptibility profiles against 13 different antifungal agents. The research also examined the geographical distribution, genetic diversity, and phylogeny of these fungi over a five-year period.

Results

Rhizopus arrhizus (67.9%, n=123) and Mucor circinelloides (23.2%, n=42) were the predominant species identified. Amphotericin B and posaconazole demonstrated the lowest geometric mean minimum inhibitory concentration values for both clinical and environmental isolates. Clinical isolates exhibited greater susceptibility to amphotericin B, posaconazole, and isavuconazole compared to environmental isolates.

Conclusion

The findings demonstrate that amphotericin B and posaconazole are the most effective antifungal agents against Mucorales isolates in Iran. Understanding the distribution and antifungal susceptibility patterns of Mucorales helps clinicians select appropriate antifungal therapies, though further studies are needed to correlate these findings with clinical outcomes.
  • Published in:BMC Infectious Diseases,
  • Study Type:Multicenter observational study,
  • Source: PMID: 40597699, DOI: 10.1186/s12879-025-11189-7
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