Cardiac surgery

- Preoperative assessment of nasal culture for S. aureus carriage should be considered.

• If nasal S. aureus (MSSA or MRSA) carrier, suggest intranasal mupirocin 2% bid for 4 days prior to surgery ± chlorhexidine 4% body wash the day prior to surgery.

NB: No evidence of benefit if not nasal S. aureus carrier.

- The safety and efficacy of topical antibiotics applied to the sternum has not been established and is currently not recommended.

- Vancomycin alone should be restricted to true cefazolin allergy as it is associated with a higher frequency of postoperative infections (including Gram positive infections).

- For patients with known MRSA colonization or past infection, add vancomycin to surgical prophylaxis regimen.