Epidemiological characteristics of six respiratory pathogens in respiratory infections in Fuzhou, China

To characterize the burden and features of respiratory pathogens infections among patients with Acute Respiratory Tract Infections (ARTIs) in Fuzhou, China. Providing evidence-based guidance for outbreak prevention. From December 2023 to February 2025, 10,355 ARTI patients at Fuzhou University Affiliated Provincial Hospital were tested for six pathogens (Influenza A virus (FLUA), Influenza B virus (FLUB), respiratory syncytial virus (RSV), Human rhinovirus (HRV), adenovirus (ADV), and Mycoplasma pneumoniae (MP)) using multiplex PCR. Detection rates and epidemiological characteristics were analyzed. Among enrolled patients, 4,699 (45.37%) tested positive. Overall pathogen detection showed no significant gender difference. However, RSV positivity was higher in males (P =0.046), while MP infection predominated in females (P <0.0001). MP predominated among single infections (14.72%), followed by HRV (13.54%), ADV (9.13%), FLUA (8.93%), RSV (3.43%), and FLUB (2.57%). Major coinfections (>1%) included HRV+MP (2.98%), ADV+MP (2.87%), HRV+FLUA (2.06%), and ADV+HRV (1.64%). These pathogens constituted the primary etiology of pediatric ARTIs. Distinct seasonal patterns emerged: FLUA peaked in spring/winter; FLUB and MP surged in winter; RSV circulated in spring/autumn; ADV prevailed in autumn/winter; HRV was endemic in summer/autumn/winter. HRV positivity correlated inversely with improved air quality (daily index <60). RSV outbreaks exhibited a lagged correlation with precipitation and demonstrated a "compensatory peak" relative to FLUA. Compared to individuals >60 years（y）: Children <7 y had significantly elevated RSV risk; Minors <18 y showed reduced FLUA susceptibility; FLUB risk increased in ages 1-60 y; Those <60 y exhibited higher ADV, HRV, and MP infection risks. Relative to winter: Spring decreased FLUA/B/MP risk but increased RSV/HRV; Summer lowered FLUB/MP risk while elevating RSV; Autumn reduced FLUA/B/ADV/MP risk but heightened RSV/HRV. Multivariate analysis identified age >60 y and RSV/HRV/MP infection as independent risk factors for lower respiratory tract involvement. The epidemiology of these six pathogens exhibits significant age-, season-, and climate-dependent variations, necessitating tailored preventive strategies. Enhanced vigilance for lower respiratory complications is warranted in individuals ≥60 y and those infected with RSV, HRV, or MP. These findings provide critical insights for targeted interventions.