Methicillin-resistant Staphylococcus aureus (MRSA) has become a concerning multidrug-resistant organism, expanding further outside the hospital setting. Cardiothoracic surgery patients are at an increased risk for mediastinitis and other surgical site infections, which may be further complicated by MRSA. To reduce MRSA surgical site infections, multidisciplinary active surveillance should be implemented in at least high-risk patients, incorporating basic infection control practices, appropriate antibiotic prophylaxis, and decolonization. This article will review the various guidelines, addressing the role of MRSA active surveillance in cardiothoracic surgery, and provide guidance for cardiothoracic surgeons.