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Background: The optimal antibiotic therapy for the treatment of hospital acquired pneumonia (HAP) caused by Methicillin-resistant Staphylococcus aureus (MARSA) is controversial especially in diabetes mellitus patients. However, certain researches recommended that linezolid is superior to vancomycin in management of HAP. Objective: To assess the effect of treatment outcomes in patients with nosocomial pneumonia caused by methicillin- resistant staph aureus in diabetic patients and non-diabetic patients. Patients and Methods: This study was conducted on 120 patients at Mansoura Chest Diseases Hospital, Mansoura, Egypt, in the period between December 2019 and August 2020 among patients whose age more than 18 years old. Group A (n=60): Diabetic cases which further subdivided into two subgroups: Group A1 (n=30): Diabetic patients with nosocomial pneumonia receiving linezolid. Group A2 (n=30): Diabetic patients with nosocomial pneumonia receiving vancomycin. Group B (n=60): Non- diabetic cases, which further subdivided into two subgroups: Group B1 (n=30): Non-diabetic patients with nosocomial pneumonia receiving linezolid. Group B2 (n=30): Non-diabetic patients with nosocomial pneumonia receiving vancomycin. Results: APACHE score and duration of hospital admission were higher in diabetic cases in comparison with non-diabetic cases with statistically significant differences. Diabetic cases were more liable for complications with a subsequent high mortality rates in comparison with non-diabetic ones irrespective of the current usage of antibiotics (weather linezolid or vancomycin). Treatment outcomes were comparable among Linezolid and vancomycin used groups. The need for mechanical ventilation was comparable among all groups with no statistically significant difference. Conclusion: Diabetic comorbidity remains the main factor that affects the outcomes and prognosis of HAP cases. Higher complications and mortality rates were more in diabetic cases owing to their renal condition and uncontrolled diabetic status. Linezolid and vancomycin have similar efficacy and safety profiles in management of HAP cases.