Rhino-orbito-cerebral mucormycosis (ROCM) in eastern Iran: a six-year dual-center retrospective observational study of 329 patients

Invasive mucormycosis is a rapidly progressive angioinvasive mycosis with high mortality. We aimed to describe epidemiology, presentation, diagnostics, antifungal utilization, in-hospital outcomes, sex-based descriptive differences, and available sociodemographic variables among patients managed at referral hospitals in eastern Iran. We conducted a retrospective observational study of all hospitalized rhino-orbito-cerebral mucormycosis (ROCM) cases at two tertiary hospitals in Mashhad, March 2018–March 2024. Inclusion required compatible clinical features plus pathological confirmation. Data were abstracted from charts, imaging archives, and pathology. Endoscopic, radiologic, and histopathologic findings; comorbidities; therapies; and in-hospital outcomes were summarized and compared using descriptive statistics. Among 329 patients (52.9% male), median age was 53 years (IQR 31–59); 71.4% lived in urban areas and 23.7% required ICU care. Diabetes was present in 45.6% and immunosuppressive therapy in 51.1%. Endoscopy ( n = 326) most often showed necrosis (54.3%) and crusting (37.4%). Across 571 imaging procedures, mucosal thickening (68.1%) and sinus opacification (67.8%) predominated; orbital involvement occurred in 13.7%. Of 495 biopsies, the nasal septum was the commonest site (22.8%); histology reported necrosis in 49.1% and angioinvasion in 4.6%. L-AmB was administered to 56.8% and deoxycholate to 28.6%; combination regimens were less frequent. Overall, in-hospital mortality was 30.4%; survival to discharge occurred in 58.7%. Standardized 6-week or 12-week mortality could not be calculated from the available retrospective records. Unadjusted survival varied across antifungal regimens, but dual and triple antifungal groups were small; therefore, these descriptive differences should not be interpreted as evidence of comparative efficacy or superiority of combination antifungal therapy. In this large retrospective cohort of referral-hospital ROCM, diagnosis commonly involved endoscopy, cross-sectional imaging, and tissue-based confirmation, and most patients received amphotericin B formulations with azole-containing combinations used in a minority. In-hospital mortality was 30.4%; however, lack of standardized severity staging, treatment-timing metrics, surgical debridement data, and antifungal dosing/duration precludes attributing outcomes to specific care processes. Observed differences between male and female patients in socioeconomic variables and regimen selection are descriptive and warrant evaluation in datasets with baseline severity and timing variables.