What is the most common cause of osteomyelitis?

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The main concept is that the most common cause of osteomyelitis is Staphylococcus aureus, because this organism is a frequent skin and nasal colonizer and has strong abilities to invade bone and persist there. It often reaches bone through the bloodstream after a minor skin infection or via direct spread from nearby tissue. Its virulence factors—such as coagulase, protein A, and bone-destructive enzymes—help it adhere to bone, break down tissue, and form biofilms, which makes the infection harder to clear and explains why it dominates as the leading pathogen in both hematogenous and contiguous osteomyelitis. The other organisms listed can cause bone infection in specific contexts (for example, E. coli in certain hospital-associated cases, Streptococcus pneumoniae in less typical scenarios, or Pseudomonas in puncture wounds or hardware-related infections), but they are far less common overall.