Introduction Despite success in tuberculosis control, multi-drug resistance tuberculosis (MDR-TB) in Bangladesh is increasing and currently MDR-TB rate is 3.6% in new cases and 19% in re-treatment cases. This study focused determination of environmental and host factors of MDR-TB which is warranted for effective prevention strategy.

Methods A case control study was conducted between January and August 2010. Purposively recruited 136 culture-proved MDR-TB cases and 152 cured TB patients were interviewed and 10 cc of blood samples were taken. Associations between exposure and outcome variables were initially tested by χ²-test, t-test, ANOVA. A result was considered significant at p value <0.05. Effects of exposure variables were also assessed after adjusting for other variables by binary logistic regression models. Crude and adjusted OR with 95% CI was computed.

Results Younger age (p=0.008), peri-urban locality (p=0.002) associated with MDR-TB. History of contact (p<0.001) and tuberculosis in the past (p<0.001) were four and eight times, respectively, more likely to influence MDR-TB. Regularity [OR 0.05; 95% CI (0.01 to 0.39)] and always observation of treatment [OR 0.25; 95% CI (0.10 to 0.61)], sputum conversion [OR 0.02; 95% CI (0.01 to 0.08)] negatively associated with MDR-TB. Gender, socio-economic status and overcrowding did not show any influence. None was HIV positive, but its risk factors were more common in MDR-TB cases. Sputum conversion was the best predictor.

Conclusion Like other developing countries previous treatment status is the most important exposure variable. Strengthening of control activities might contribute in preventing development of resistance in tuberculosis patients.