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A Cannas,1 O Butera,1 G Gualano,2 MP Parracino,3 C Venditti,1 A Mazzarelli,1 F Palmieri,2 E Girardi,3,* A Di Caro1,* 1Microbiology and Bio-Repository Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy; 2Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy; 3Clinical Epidemiology Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Rome, Italy*These authors contributed equally to this workCorrespondence: A CannasNational Institute for Infectious Diseases “L. Spallanzani” IRCCS, Via Portuense 292, Rome 00149, ItalyTel +39 06 5517 0905Email angela.cannas@inmi.itPurpose: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in low incidence countries in Europe. The aim of this study was to attempt to have a better insight into the trends of MDR-TB in the metropolitan area of Rome, within the Italian and the foreign-born population, based on microbiological and demographic data.Patients and methods: We performed a prospective study, collecting microbiological data based on phenotypic drug-resistant testing (DST) of TB strains consecutively isolated in a referral hospital in Rome, the capital city of a low TB incidence country, over a 6-year period, and correlated them to the geographical origin of patients. This study was carried out in a referral hospital for patients with drug-resistant TB from the whole region.Results: Drug-resistance data from 926 patients with a microbiological diagnosis of TB from 2011 to 2016 show a 5.5% rate of MDR-TB, mostly occurring in patients born in a single East European country, that has a high incidence of MDR-TB. The strains isolated from these patients frequently carry additional resistances, leading to an increased risk of developing extensively drug-resistant (XDR) TB.Conclusion: In the great metropolitan area of Rome, MDR-TB more frequently occurs in patients who were born in a single country from Eastern Europe known to have high rates of MDR-TB and long-time residents in Italy. Recent immigrants from non-European countries do not appear to contribute to the rates of MDR-TB reported in this article. This knowledge of local TB trends could help improve the measures of surveillance and prevention of disease.Keywords: tuberculosis, drug-susceptibility testing, MDR-TB, XDR-TB