Objective　To understand the epidemiological characteristics, resistance screening status, and resistance profiles among newly diagnosed and relapsed pathogenic positive pulmonary tuberculosis patients with rifampicin resistance in Xinjiang, providing a reference for the prevention and control of rifampicin-resistant tuberculosis (RR-TB). Methods　Data on tuberculosis patient case records in Xinjiang from 2018 to 2023 were collected from the "Tuberculosis Information Management System", a subsystem of "China Information System for Disease Control and Prevention". The epidemiological characteristics of newly diagnosed and relapsed pathogenic positive patients, different demographic distributions, comorbidities such as diabetes, and rifampin-resistant pulmonary tuberculosis patients across different regions of Xinjiang were analyzed. Results　From 2018 to 2023, a total of 196 873 cases of pulmonary tuberculosis patients were registered in Xinjiang, including 83 967 cases of pathogenic positive cases. Rifampin resistance screening was conducted for 71 821 cases, resulting in a screening rate of 85.53%. The rifampin resistance screening rates varied significantly across years, ranging from 37.30% to 99.55%, the difference was statistically significant (χ²=1 020.759, P<0.001). A total of 2 573 cases of rifampin resistance were identified, with an overall resistance rate of 3.58%. The screening rate of RR in different years ranged from 37.30% to 99.55%, (χ²=1 020.759, P<0.001). The rate of RR in new pathogenic positive patients (2.04%) was significantly lower than that in retreatment patients (9.83%), the difference was statistically significant (χ²=2 003.967, P<0.001). Male patients had a higher resistance rate (1 497 cases, 4.01%) compared to female patients (1 076 cases, 3.12%), with a male-to-female ratio of 1.39∶1. The highest proportion of resistance cases was observed in the age group of >30-45 years (465 cases, 4.81%). Patients working in the commercial service sector showed the highest resistance rate (21 cases, 4.30%). Across Xinjiang, rifampin resistance rates varied between 2.00% and 7.10%, with the highest rate observed in Bortala Prefecture. Conclusion　The rifampin resistance rate in pulmonary tuberculosis cases in Xinjiang has shown an annual decline. Priority groups for resistance prevention and control include retreatment patients, males, young adults aged >30-45 years, and individuals working in the commercial service sector.