OBJECTIVE Although progress has been made to reduce the global incidence of tuberculosis, the emergence of multidrug-resistant tuberculosis during the past decade threatens to limit these results. The aim of this study is to evaluate the geographic distribution, clinical and microbiological characteristics and outcomes of multidrug-resistant tuberculosis patients in Spain. METHODS Retrospective study between January 1998 and December 2010 of patients attended in Cantoblanco-La Paz Hospital Isolation Internal Medicine Unit. RESULTS Forty-seven patients were studied, with a mean age of 36 years. There were 33 male. Sixty-four per cent were immigrants and the mean residence time in Spain was 12 months. Twenty-six patients (55.3%) were new cases. Patients were resistant to a median of 5 drugs (interquartile range [IQR] 3-7) and 3 patients had extensively drug-resistant tuberculosis. Cultures became negative after a median of 68.5 days (IQR 49.5-91.8). The median length of hospitalization was 2.75 months (IQR 1.3-4.6). They were treated during a median of 22.4 months (IQR 15.3-24.3). The overall success rate was 93%. A directly observed treatment was carried out in 79% of patients. Sixty-eight per cent patients presented side effects. In 75% of the cases the effects were mild and moderate with no need to replace the drug. Fourteen patients were followed up for a median of 40.5 months (IQR 7.4-55) and no clinical or bacteriological manifestation of disease was detected. CONCLUSIONS Most patients with multidrug-resistant tuberculosis can be cured with the use of appropriate and intensive regimens, management of side effects and implementation of strategies to improve adherence to treatment.