Objective  To understand the epidemiological characteristics of multiple pathogen infections in patients with acute respiratory tract infections in Ma’anshan, Anhui province, and provide evidence for disease prevention and control as well as medical treatment.

Methods A retrospective analysis was conducted on influenza like illness (ILI) and severe acute respiratory infection (SARI) cases detected in Ma'anshan from October 2023 to October 2025. Respiratory sample, including throat swabs, were collected and tested for 13 common respiratory pathogens by using fluorescence polymerase chain reaction. Statistical analyses and data visualization were performed using software. Python 3.9.18.

Results A total of 4 728 ILI or SARI cases were included, with an overall respiratory tract pathogen positive rate of 44.14%. The five most frequently detected pathogens were influenza virus (10.38%), SARS-CoV-2 (6.79%), adenovirus (ADV) (5.41%), rhinovirus (RV) (5.08%), and Streptococcus pneumoniae (4.82%). Significant differences in positive rates of respiratory syncytial virus(RSV), ADV, RV, enterovirus (EV), coronavirus (COV), influenza virus, and Mycoplasma pneumoniae were observed among different samples (P<0.05). The positive rates of RSV, ADV, RV, human metapneumovirus, EV, novel coronavirus（SARS-CoV-2）, influenza virus, M. pneumoniae, S. pneumoniae , and Chlamydia pneumoniae varied significantly between ILI cases and SARI cases (P<0.05). With the exception of SARS-CoV-2 (P<0.001), influenza virus (P<0.05), and S. pneumoniae (P<0.05), no significant gender specific differences in positive rate were observed (P>0.05). The overall positive rates in age groups 0–, 5–, 15–, 25–, and ≥60 years were 58.39%, 52.57%, 36.69%, 42.56%, and 34.98%, respectively, the differences were significant (P<0.001). The positive rate was 40.69% in spring, 42.29% in summer, 39.97% in autumn, and 55.54% in winter, showing significant seasonality (P<0.001). In theco-infection cases, S. pneumoniae was the most common pathogen, followed by RV.

Conclusion From October 2023 to October 2025, respiratory tract infections exhibited clear seasonal patterns in Ma’anshan, with the transitional peaks in spring and autumn, low incidence in summer, and spread in winter. Age-specific trends indicated that pathogen spectrum diversity decreased with age. Gender specific pathogen detections were observed, with higher proportions in women in specific age groups, whereas pathogen spectrum distribution was not specific in men. Co-infections were not randomly distributed but demonstrated marked specific pathogen combinations.