Objective：To evaluate the performance of sputum smear negative conversion as an early indicator of treatment success in multidrug-resistant tuberculosis patients. Methods：This study was performed in four cities，including Xuzhou，Zhenjiang，Lianyungang， and Nantong in Jiangsu Province of China. All multidrug-resistant tuberculosis patients were successively enrolled in the study between December 2011 and March 2014 to analyze the possible factors that may affect sputum negative conversion. Results：A total of 127 patients were enrolled in our study. Among them，106 （83.5%） had a sputum smear conversion，with the median conversion time of 145 d （inter-quartile range：102 to 228 d）. Besides，81（63.8%） were cured； 46（36.2%） were failed or dead. Smoking（HR=0.561，95%CI：0.320-0.984，P=0.044），ofloxacin resistance（HR=0.556，95%CI：0.317-0.975，P=0.041） and sputum smear grading>1（HR=0.557，95%CI：0.334-0.928，P=0.025） were risk factors for sputum smear conversion. Conclusion：Smoking，ofloxacin-resistance，and high smear grade are risk factors for sputum smear negative conversion in multidrug-resistant tuberculosis patients in Jiangsu Province.