Respiratory Pathogen Spectrum Among 12,220 Testing Episodes for Clinically Suspected Acute Respiratory Infection in Predominantly Hospitalized Patients at a Tertiary Hospital in Wuhan, China, 2025: A Retrospective Cross-Sectional Study

Acute respiratory infections (ARI) impose a substantial global disease burden, yet the post-pandemic pathogen spectrum in central China remains incompletely characterized. This single-center retrospective cross-sectional study analyzed 12,220 consecutive testing episodes in which a 12-pathogen multiplex PCR panel was ordered for selected patients with clinically suspected ARI at Wuhan No. 1 Hospital in 2025; 99.7% occurred during hospitalization. Overall pathogen detection was 30.3% (3705/12,220). Human rhinovirus was the most frequently detected pathogen (8.84%), followed by influenza A virus (5.29%), respiratory syncytial virus (4.75%), SARS-CoV-2 (4.13%), and human coronavirus (3.77%). Detection rates varied by age (children 60.4% vs. adults 23.3% and elderly 24.6%) and season (autumn 34.1%, winter 33.1%, spring 29.2%, summer 25.4%), with a monthly peak in November (39.3%) and trough in August (21.5%). Co-detection of two or more pathogens occurred in 343 positive episodes (9.26%), with HRV plus RSV being the most common pairing (12.8%). In multivariable analysis, clinical department (pediatrics aOR 5.84, 95% CI 3.69–9.49; hematology aOR 2.19, 95% CI 1.76–2.74) and season (autumn aOR 1.57, 95% CI 1.39–1.77) were independently associated with pathogen detection, whereas sex was not. The strong pediatric age association (aOR 4.99, 95% CI 4.42–5.65) was attenuated to non-significance after adjustment for department (aOR 1.30, 95% CI 0.82–2.00), reflecting near-complete overlap between young age and pediatric attendance, which precludes separation of the two effects; within childhood, detection nevertheless decreased with increasing age (p for trend < 0.0001). These findings characterize pathogen detection among predominantly hospitalized patients with clinically suspected ARI at a single tertiary center and may inform local diagnostic stewardship and infection-control practice.