In some settings, susceptible-dose dependent (SDD) categorization is used: isolates with intermediate MICs may still respond to higher fluconazole doses, but the presence of ERG11 mutations often reduces the likelihood of clinical success even with dose escalation. ( PMC ) Beyond single substitutions, clinical isolates frequently carry combinations of ERG11 changes plus efflux-regulatory mutations (e.g., TAC1 gain-of-function) that together produce higher MICs and poorer outcomes; thus, sequencing plus expression data can refine prognostic interpretation.
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