In patients with sickle cell disease, bone infarctions create a favorable environment for Salmonella species to invade, leading to osteomyelitis. Unlike the general population where Staphylococcus aureus is the most common cause, Salmonella has a unique predilection for sickled, infarcted bone tissue. The impaired splenic function in these patients reduces clearance of encapsulated bacteria like Salmonella, increasing susceptibility. Therefore, Salmonella species are the most common causative organisms of osteomyelitis in sickle cell disease. Early recognition and targeted antibiotic therapy are critical to avoid complications.

Reference: Harrison's Principles of Internal Medicine, 20th Edition.