Survival and renal outcomes of mucormycosis infection and its treatment regimens in resource-limited settings: a retrospective case series.

Mucormycosis is a rapidly progressive opportunistic fungal infection associated with high morbidity and mortality, especially in immunocompromised patients. In resource-limited settings, management is further hindered by delayed diagnosis and restricted access to safer antifungal formulations. To evaluate survival and renal outcomes among patients with mucormycosis treated with different antifungal regimens. A retrospective review was conducted on 19 patients diagnosed with mucormycosis. Clinical features, comorbidities, antifungal therapy, complications, and outcomes were analyzed. Patients were categorized into five treatment groups based on antifungal regimens. Survival and renal outcomes, including acute kidney injury (AKI) and renal recovery, were assessed. Most patients were diabetic (94.7%), and 52.6% had concurrent or recent COVID-19 infection. All had paranasal sinus involvement, with orbital or palatal extension in 68.4% and CNS involvement in 42%. AKI developed in 68.4% of cases, more common with traditional amphotericin regimens (75%) than with liposomal amphotericin (33.3%). Among those with AKI, 38.5% recovered, while 53.8% progressed to chronic kidney disease. Hypersensitivity reactions occurred in 31.6%, mainly with traditional amphotericin. Overall survival was 84.2%, and prolonged antifungal therapy (> 40 days) with early surgical debridement improved outcomes. The study highlights a substantial gap between international guidelines and real-world practice in low-resource environments, where inconsistent access to liposomal amphotericin limits optimal management. Nevertheless, with early diagnosis, aggressive surgical intervention, and vigilant renal monitoring, favorable outcomes are achievable even with traditional amphotericin. Improving national antifungal procurement, strengthening stock management, and subsidizing liposomal formulations could significantly enhance mucormycosis care in resource-limited settings.