To determinate a retrospective analysis of multidrug-resistant pulmonary tuberculosis associated with risk factors in a marginal urban district Design: The type of research was observational and analytical, retrospective case and control. The sample consisted of 40 cases diagnosed with MDS TB by Sensitive Test; for each case, two controls were considered that were people who live in the same district, with a smear-positive diagnosis of pulmonary tuberculosis, pansensitives, that is, 80 controls with FP-TB. The data collection technique was the survey and the instrument, a questionnaire for both groups (cases - controls). Results: Six internal and external risk factors associated with MDR TB were identified. The internal risk factors associated with MDR TB were: previously receiving one or more treatments for tuberculosis, consumption of drugs before having pulmonary TB and presence of a higher bacillary load in the BK result and pretreatment (p < 0.05) culture (+++). The external risk factors associated with MDR TB were:contact with a family member with MDR TB; contact with friends or neighbors who died from TB and contact with someone with MDR TB outside the home (p < 0.05). Conclusion: The Factors: "Presence of a higher bacillary load in the BK result and pretreatment culture (+++)"and "Contact with someone you know with MDR TB outside the home"are more significantly associated with MDR TB, if the incidence of these risk factors can be controlled, the progression of tuberculosis can be stopped.