Table 1.

Main developments that have changed the management of pediatric skeletal system infections in recent years.

Area	Game-changing development	References
Epidemiology and etiology	Vaccination against Haemophilus influenzae type b and Streptococcus pneumoniae	(5, 6)
	Emergence of Panton-Valentine leukocidin (PVL)-producing community-associated methicillin resistant S. aureus (MRSA)	(7)
	Recognition of Kingella kingae as the prime etiology of skeletal system infections in the 6–48-months old group	(8)
	Realization that the etiology of pediatric osteoarthritis is age-dependent	(8)
Clinical features	Recognition of the mild local and systemic inflammation characteristics of K. kingae's OAIs	(9, 10)
	Use of serum CRP levels to assess clinical response and shift from parenteral to oral antibiotics	(1, 3)
Diagnosis	Use of MRI to improve diagnosis of bone infections and determine their extent	(11)
	Development of improved culture methods and nucleic acid amplification tests	(12–14)
	Rapid identification of the isolate by molecular methods and MALDI-TOF technology	(15)
	Emergence of the metagenomic next-generation sequencing as a microbiological diagnostic tool	(16)
Therapy	Increasing use of oral therapy, replacing the traditional prolonged intravenous antibiotic regimens	(17, 18)
	Abolishing the need to determine serum cidal levels to shift from parenteral to oral therapy	(1, 19)