This report describes and evaluates four patients with hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infections at the Burns and Plastic Surgery Hospital, in Libya, between August 1999 and August 2002. Neither rifampicin nor vancomycin was used to treat these patients. Inhalation injury with major burns (> 60% total body surface area), a major degree of burns (3rd degree), and septicaemia caused by both MRSA and multi-resistant P. aeruginosa invariably proved fatal. One patient responded well to antibiotic therapy, but the other three died in spite of similar therapy. Vancomycin and rifampicin should be established as the first choice to treat MRSA infection, and infected wounds need aggressive management with antibiotics prior to skin grafting.