Ribosomal protection as a linezolid resistance mechanism in Mycobacterium abscessus

Antimicrob Agents Chemother. 2026 Apr;70(4):e0160525. doi: 10.1128/aac.01605-25. Epub 2026 Mar 2.

Abstract

Mycobacterium abscessus has emerged as a significant pulmonary pathogen characterized by its resistance to most first-line antimycobacterial drugs. Recent investigations have highlighted the clinical efficacy of including the oxazolidinone antibiotic linezolid in M. abscessus combination therapies, despite moderate resistance frequently being observed in patient isolates. Even with the potential usefulness of linezolid, the mechanisms that drive linezolid resistance in M. abscessus remain poorly understood. In several bacterial pathogens, including Mycobacterium tuberculosis, ATP-binding cassette (ABC) family proteins of the F subtype (ABC-F) have been found to confer antibiotic resistance to ribosome-targeting antibiotics, including linezolid. Here, we identified an M. abscessus ABC-F protein, MAB_2736c, that causes specific resistance to antibiotics that bind the 50S ribosomal subunit, including linezolid, macrolides, and chloramphenicol. These results demonstrate that targeting ABC-F proteins could help combat intrinsic resistance to several ribosome-targeting antibiotics in mycobacteria.

Keywords: ABC-F proteins; Mycobacterium abscessus; antibiotic resistance; antibiotics; mycobacteria; ribosomal protection.

MeSH terms

  • Anti-Bacterial Agents* / pharmacology
  • Bacterial Proteins / genetics
  • Bacterial Proteins / metabolism
  • Chloramphenicol / pharmacology
  • Drug Resistance, Bacterial* / genetics
  • Humans
  • Linezolid* / pharmacology
  • Macrolides / pharmacology
  • Microbial Sensitivity Tests
  • Mycobacterium abscessus* / drug effects
  • Mycobacterium abscessus* / genetics
  • Mycobacterium abscessus* / metabolism
  • Ribosomes* / drug effects
  • Ribosomes* / metabolism

Substances

  • Linezolid
  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Chloramphenicol
  • Macrolides