Mycobacterial HflX is a ribosome splitting factor that mediates antibiotic resistance

Significance The erm41 gene is considered the primary mechanism of intrinsic resistance to macrolides in Mycobacterium abscessus . Here we demonstrate that the hflX gene plays a significant and equally important role as erm41 . We further describe an unusual mechanism of resistance to macrolide-lincosamide antibiotics mediated by the mycobacterial HflX that likely involves the dissociation of antibiotic-stalled ribosomes. An understanding of the various mechanisms employed by bacteria for resistance to an antibiotic is critical in predicting an effective therapeutic regimen against a pathogenic isolate, and can also inform the development of novel drugs.