Multidrug-resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis resisting at least isoniazid and rifampicin. MDR is a major public health threat in Sudan. This is a descriptive cross-sectional and hospital-based study conducted in Kosti teaching hospital, during the period from December 2019, to December 2021, aimed to determine the prevalence of Multi-Drug resistance among TB patients and to find the most risk factors associated with generating TB resistance, using Xpert MTB/RIF assay. One thousand sputum samples from suspected TB patients were applied on Xpert MTB/RIF automated sample processing and used for ZN stain. Blood samples from the same subjects were used for the detection of HIV infection by ICT. By gene Xpert method, MTB was detected in 218 subjects. Remarkably, out of 218MTB detected by Xpert MTB/RIF assay, 13/218 (5.9%) were positive for MDR. Participants who live in rural had higher rates of MDR 8(2.4%) than urban areas 5(0.8%) with a significant statistical association. The frequency of MDR is significantly lower in subjects aged 21-40 years compared to others. It is also lower in those who showed a negative result for bacillary level but higher in subjects who were positive for ZN stain 4(2.9%), with P less than 0.05. There was an emerging MDR-TB in White Nile State that needs prompt response via early diagnosis and management of TB patients along with social awareness.

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