Information about the changing epidemiology of drug-resistant tuberculosis (TB) in hospitals in China over the past decade remains largely unknown. This study examined the susceptibility patterns and trends of drug-resistant TB cases in the 309 Hospital in Beijing, China. Mycobacterium tuberculosis isolates were retrospectively identified, drug susceptibility test (DST) results and clinical data were analysed for the period 1997-2009. Of the 5523 culture-positive TB patients, 47·1% had resistance to any anti-TB drug, 14·8% had mono-resistant TB, 19·8% had poly-resistant TB, 19·4% had multidrug-resistant TB (MDR-TB), and 1·3% had extensively drug-resistant TB (XDR-TB). Drug-resistant TB was significantly associated with age group, residential situation, and TB treatment history (P<0·001). During 1997-2000, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all increased significantly (P<0·001). During 2000-2003, the increasing trends of MDR-TB and XDR-TB cases were reversed. During 2004-2009, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all declined significantly (P<0·001), but the prevalence of MDR-TB and poly-resistant TB cases remained high. Our study provides evidence demonstrating that intensive TB control measures have helped reverse the increasing trends of drug-resistant TB in China, but continuous surveillance of drug-resistant TB and better case management are still needed to further reduce the remaining high prevalence of drug-resistant TB.