Objective:

To explore the phenomenon of culture-negative osteoarticular infections (OAIs) in children, focusing on their microbiological basis, the role of atypical microorganisms, and the impact of modern diagnostic technologies, highlighting the clinical significance of these findings.

Key Findings:

• 24%–68% of acute hematogenous osteomyelitis and 21%–70% of septic arthritis cases remain culture-negative, as reported in multiple studies.
• Kingella kingae is now recognized as the most common pathogen in children under 4 years of age, according to recent epidemiological data.
• PCR-based assays significantly increase pathogen identification rates compared to conventional culture methods, with specific studies demonstrating this improvement.
• Subacute hematogenous osteomyelitis (SAHO) often goes unrecognized but shows high PCR positivity rates, indicating the need for increased awareness and diagnostic efforts.

Interpretation:

The persistent culture-negative status of many OAIs indicates a need for improved diagnostic methods to identify fastidious organisms, which could enhance treatment outcomes and inform antibiotic stewardship.

Limitations:

• The review highlights a lack of validated primers for many fastidious organisms, which limits diagnostic capabilities.
• The reliance on historical data may not fully represent current epidemiological trends, potentially skewing understanding of the current landscape.

Conclusion:

Future research should focus on identifying additional causative organisms in culture-negative OAIs, utilizing advanced genomic techniques such as next-generation sequencing to enhance diagnostic accuracy.