TABLE 5.

Results for 5 C. albicans isolates displaying fluconazole MIC values of ≥4 μg/ml

Country or U.S. state	MLSTa	MIC (μg/ml)b		Gain-of-function alterationsc			Relative mRNA expression levele
		FLU	VOR	Erg11	Erg3	MDR promoter allele sequenced	Erg11	MDR1	CDR1	CDR2
Romania	3212	4	0.015		A351V, A353T		0.52	11.21	0.23	2.13
France	3213	8	0.015				0.83	86.87	0.48	5.33
United Kingdom	3216	8	0.06				1.15	200.64	2.55	0.92
Washington	3214	8	0.12				0.80	0.58	1.84	27.74
New York	3215	64	1	G450E, G464S		A/A	1.07	0.28	1.15	8.24

^aMLDT, multilocus sequence type.

^bFLU, fluconazole; VOR, voriconazole.

^cOnly gain-of-function mutations previously associated with azole resistance are listed. For a complete list of alterations in Erg11, Erg3, UPC2, MRR1, MDR1, CDR1, CDR2, and TAC1, see Table S2 in the supplemental material.

^dHomozygous alleles (A/A) in the MDR promoter confer higher levels of MDR1 expression and resistance to fluconazole.

^emRNA expression levels were quantified relative to those of the 18S rRNA gene. Underlined data indicate increased expression levels.