97% of patients received perioperative antimicrobial prophylaxis with a cephalosporin.
Risk factors for methicillin-resistant Staphylococcus aureus (MRSA):
(1) female gender
(2) age > 70 years of age
(3) diabetes mellitus
Risk factors for methicillin-susceptible Staphylococcus aureus (MSSA):
(1) obesity
The effect of MRSA prevalence in the community or in the medical center was not mentioned. This may not have been evident since the study was done in one medical center.
The authors found that mortality was 11-fold higher in patients with MRSA mediastinitis, with a significant increase in healthcare costs.
Ways to reduce risk of MRSA:
(1) select an antibiotic for prophylaxis with activity against MRSA
(2) preoperative therapy with mupirocin
(3) tight control of glucose in diabetes
Additional ways of reducing the risk (not listed in paper):
(4) careful attention to the preoperative bathing protocol (this may contain one or more gaps when scrutinized)
(5) protocol for survey cultures in high risk patients
(6) protocol for survey cultures in health care workers
