This study aimed to determine the distribution of vancomycin (VAN) MIC values and antimicrobial resistance patterns of MRSA nosocomial isolates from a Saudi tertiary care hospital and evaluate the presenting clinical and demographic features of different infections caused by these isolates. A total of 104 non-duplicating MRSA nosocomial strains were isolated. VAN MICs were determined by standard Etest and the Etest macromethod (MET). Among all isolates, 7.7% had a MIC = 2 μg/ml, 70.2% had a MIC = 1 μg/ml and 22.1% had a MIC = 0.5 μg/ml. No heterogeneous VAN-intermediate S. aureus (hVISA) were detected. Patients infected with high VAN MRSA nosocomial isolates were of significantly older age (p = 0.035), presented more often with bacteraemia (p = < 0.0001) and had longer hospital stays (p = < 0.0001). The presence of high VAN MICs of some MRSA isolates in our hospital is worrying and a cause for concern due to the possibility of the potential failure of treatment of these isolates. Moreover, accurate MIC testing using MET simultaneously or as a supplement to automated systems (i.e. Vitek) is important.