Staphylococcus aureus is a common cause of hospital- and community-acquired infections. The development of vancomycin-resistant enterococci in 1988 led the way to the emergence of vancomycin-resistant S. aureus (VRSA) (minimum inhibitory concentration [MIC] > or =32 microg/mL [3]), first recognized in 2002. This report describes the third documented clinical isolate of VRSA from a patient in the United States and provides evidence of failure to detect this VRSA by commonly used automated antimicrobial susceptibility testing.