Acquisition of clofazimine resistance following bedaquiline treatment for multidrug-resistant tuberculosis

•The high rate of CFZ resistance among MDR-TB patients in China.•Patients treated with BDQ-containing regimens achieve comparative culture conversion rate regardless of baseline CFZ susceptibility.•The presence of acquired CFZ-resistance following BDQ treatment without known mutation indicates that other mechanisms conferring cross resistance to these two compounds may exist, and the whole genome sequencing analyses of the two isolates will be necessary to determine these novel mechanisms.