We conducted a nasal culture surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired pneumonia (CAP) and nursing and healthcare-associated pneumonia (NHCAP) at our emergency ward. Out of 730 patients (271 CAP and 459 NHCAP), 91 (12.5%) had nasal MRSA-positive culture. The nasal MRSA-positive frequency was higher in NHCAP than in CAP [78 cases (17.0%) vs. 13 cases (4.8%), p<0.01]. The nasal MRSA-positive group in NHCAP (n=78) had higher severity of pneumonia (A-DROP score: 2.8±1.1 vs. 2.4±1.1, p=0.001); had higher frequency of initial treatment failures (21.8% vs. 13.2%, p=0.048); and had higher frequency of placed percutaneous endoscopic gastrostomy tube (20.5% vs. 6.6%, p<0.01), compared with the nasal MRSA-negative group in NHCAP (n=381). In NHCAP, MRSA was more frequently isolated from the sputum culture (35.9% vs. 2.4%, p<0.01) and the blood culture (2.6% vs. 0%, p=0.002) in the nasal MRSA-positive group compared with the negative group. No patients were diagnosed with MRSA pneumonia in the nasal MRSA-negative group in NHCAP. For the diagnosis of MRSA pneumonia in NHCAP, the nasal MRSA culture screening showed 100% sensitivity and 83.6% specificity and had positive and negative predictive values of 3.8% and 100%, respectively. In conclusion, nasal culture surveillance may be beneficial in guiding empiric anti-MRSA therapy in NHCAP.