Purpose <p>To evaluate diagnostic performance of four diagnostic methods for rapid determination of methicillin resistance in <i>S. aureus</i> positive blood cultures (BCs).</p> Methods <p>Clinical and spiked BCs were subjected to the evaluation of the following methods and protocols: a. Eazyplex^® MRSA Plus loop‐mediated isothermal amplification (LAMP) assay directly from BC fluid; b. MALDI-TOF MS subtyping on BC pellet extracted with Rapid Sepsityper^® protocol and on 4-h short-term subculture; c. Clearview™ Culture Colony&#xa0;PBP2a SA immunochromatography assay on BC pellet and on 4-h short-term subculture; d. EUCAST RAST cefoxitin screen test performed directly from BC and including reading times at 4-h, 6-h and 16–20-h.</p> Results <p>Eazyplex^® MRSA plus exhibited the best performance, showing 100% sensitivity, specificity, positive predictive value, and negative predictive value, followed by PBP2a SA Culture Colony Clearview assay and EUCAST RAST cefoxitin screen. MALDI-TOF MS subtyping showed the lowest diagnostic accuracy (59.8 and 65.7% directly from BC and from 4-h subculture, respectively). In detail, sensitivity and specificity ranged from 24.3% to 20.4% and from 88.9% to 98.3% for protocols performed from BC pellet and 4-h subculture, respectively.</p> Conclusions <p>The Eazyplex^® MRSA Plus and the immunochromatographic Clearview™ PBP2a SA Culture Colony methods can provide reliable results within 1&#xa0;h from the start of positive BC processing. MALDI TOF MS subtyping showed unacceptable specificity by performing analysis from BC pellets, while its sensitivity depends on the prevalence of PSM-positive MRSA strains. The EUCAST RAST, based on disc diffusion, showed excellent performance with a time-to-result of at least 4&#xa0;h.</p>