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Summary: Epidemic spread of methicillin-resistant Staphylococcus aureus (MRSA) strains carrying the Staphylococcal Chromosomal Cassettes (SCC) mec type IV is being increasingly reported in many geographical areas. A survey to determine the prevalence and characteristics of MRSA SCCmec IV isolates identified in four general hospitals in Palermo, Italy, was carried out. During the period February–June 2009, SCCmec type IVa has been found in 12 out of 94 isolates. Nine isolates from all hospitals and all strains from a NICU outbreak occurring in the same period were attributed with the ST22-IVa (EMRSA-15) clone. In our setting, due to the changing MRSA epidemiology, detection of SCCmec IV could be poorly predictive of CA-MRSA. Keywords: MRSA, ST22-IVA, EMRSA-15, Epidemiology, Molecular typing