Bacterial respiratory infections in children: advances in diagnostic strategies.

INTRODUCTION: Respiratory tract infections (RTIs) are among the most common causes of medical consultation in children. Although the majority of upper respiratory tract infections are viral and self-limiting, bacterial pathogens remain responsible for a relevant proportion of cases and may require targeted antimicrobial therapy. Accurate microbiological diagnosis is therefore essential to guide clinical management and support antimicrobial stewardship.

AREAS COVERED: This review discusses the etiology and clinical presentation of pediatric respiratory infections and examines current diagnostic approaches, including traditional culture-based methods and nucleic acid amplification tests (NAATs). The advantages of molecular diagnostics-such as rapid turnaround time, high sensitivity, and improved pathogen detection-are highlighted alongside their role in antimicrobial stewardship and public health surveillance. At the same time, important limitations are explored, including difficulties in distinguishing colonization from active infection, challenges in polymicrobial detection, absence of host-response information, and barriers related to cost and accessibility. Emerging technologies and future perspectives in pediatric molecular diagnostics are also addressed.

EXPERT OPINION: While molecular diagnostics have transformed pathogen detection, their clinical interpretation remains complex. Future diagnostic strategies should integrate molecular data with quantitative pathogen measurements, host-response biomarkers, and clinical phenotyping to better distinguish infection from colonization. Interdisciplinary research, real-world implementation studies, and cost-effectiveness evaluations will be essential to translate technological advances into meaningful improvements in pediatric infectious disease care.