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Vancomycin-intermediate Staphylococcus aureus (VISA) organisms have minimum inhibitory concentrations (MICs) of 4 to 8 microg/mL and are often associated with vancomycin treatment failure. Detection of VISA has remained problematic. A comparison of 4 methods to detect VISA was done. Of the 20 VISA isolates, the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method yielded susceptible end points of 2 microg/mL for 7, MicroScan (Siemens Healthcare Diagnostics, West Sacramento, CA) for 2, Trek Sensititre (Trek Diagnostic Systems, Cleveland, OH) for 1, and Etest (AB Biodisk North America, Piscataway, NJ) for none. Comparison with the CLSI method showed essential agreement for 95% or more for the Etest, MicroScan, and Trek methods; categorical agreement was as follows: Etest, 60%; MicroScan, 65%; and Trek, 60%. Reliance on a single automated method for determining vancomycin MICs could lead to misclassification of some VISA isolates as vancomycin susceptible. At least 2 methods, including the Etest, should be used when confirming VISA because of slight differences in results from different methods around the end points of 2 and 4 microg/mL .