The overall incidence of osteomyelitis in adults is

21.8 cases per 100,000 persons annually in the United States, with approximately 20% of these cases attributed to hematogenous spread [9]. The condition shows a higher prevalence in males and increases with age, although the reasons for this gender disparity remain unclear. In pediatric pop­ulations, the incidence of osteomyelitis varies, often inuenced by different etiological factors compared to adults. Staphylococcus aureus is the most common pathogen implicated in both acute and chronic osteomyelitis, along with coagulase­negative staphylococci, aerobic gram-negative bacilli, Enterococcus, and various Streptococcal species [5]. The clinical presentation of osteomy­elitis is heterogeneous, affecting individuals across all age groups and patient types (Table1.1). High-risk and life-threatening conditions that predispose individuals to osteomyelitis and sys­temic infections include immunosuppression, diabetes with peripheral neuropathy, sickle cell anaemia, microangiopathies such as cardiovascu­lar disorders and smoking, and intravenous drug use. These conditions signicantly increase the risk of severe systemic infections. In immuno­compromised patients, a broader spectrum of pathogens is observed, including Mycobacterium tuberculosis and Bacillus Calmette-Guérin in patients with bladder carcinoma, and fungal pathogens such as Candida species, Blastomyces, Cryptococcus, and Aspergillus. Bartonella henselae is associated with HIV-positive patients, and Pseudomonas and Enterococcal infections are frequently seen in intravenous drug users, whereas Eikenella corrodens and Pasteurella

multocida are common following dog or human bites, respectively [10–13].

On the other hand, with the advent of joint replacement surgeries, prosthetic joint infections became a signicant clinical issue in the modern age [14, 15]. The other two elds of interest on BJIs are the Healthcare-Associated Infections due to the increased use of invasive procedures and devices in hospitals led to a rise in nosoco­mial infections, and the emergence of antibiotic­resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), that has com­plicated the management [16–18].

Before the discovery of penicillin, osteomyelitis management was primarily surgical, involving debridement, saucerization, and wound packing to facilitate secondary healing. This approach carried a high mortality rate due to sepsis. The introduction of antibiotics is considered a “game­changer” as they signicantly reduced the mor­tality from staphylococcal osteomyelitis. However, with the emergence of antibiotic­resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA), which account for approximately one-third of all staphylococcal infections [27], put the dealing physicians are faced with less effective treatments that necessi­tate more aggressive approaches [28]. Recent studies have validated a multidisciplinary treat­ment approach involving orthopedic surgeons, infectious disease specialists, radiologists, nurses, pediatricians, and social workers [29–31]. Evidence-based guidelines emphasize tailoring antibiotic regimens to the specic microorganism

informed consent was obtained from patients at the time of admission to our Institute. However, all pictures have been reported anonymized.