Evolving paradigms in pediatric osteomyelitis: modern insights into an old disease

Acute hematogenous osteomyelitis (AHO) remains a potentially devastating infection in children, in which delayed diagnosis or inadequate therapy can result in significant long-term sequelae. This review provides an update of the epidemiology, diagnosis and management of pediatric AHO, with particular emphasis on emerging diagnostic tools and evolving therapeutic strategies aimed at preventing complications.

Improved recognition by clinical and laboratory algorithms of age-specific pathogens, like Kingella kingae in young children or highly virulent organisms including methicillin-resistant Staphylococcus aureus (MRSA), may allow for individualized therapy. Novel molecular techniques, such as metagenomic next-generation sequencing (mNGS), offer the potential for broader and faster microbiological diagnosis. Multidisciplinary protocols that integrate early MRI may enhance anatomic delineation of infection and lead to faster detection of complications. Antibiotic stewardship programs based on local epidemiology support optimized empiric and targeted therapy, while early transition to oral antibiotics has been shown to improve quality of life and reduce healthcare resource utilization without compromising clinical outcomes.

Although AHO continues to pose diagnostic and therapeutic challenges, its management is shifting toward individualized, evidence-based care driven by advances in diagnostics, risk stratification and antimicrobial stewardship. Future research should focus on developing and validating multidisciplinary protocols to further improve the accuracy of diagnosis.