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Pathogen profiles and co-detection characteristics of acute respiratory infections based on active surveillance in a large district of southern China
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DOI：10.3389/fpubh.2026.1854385.png)
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Abstract
En 中文
ObjectiveThe objective of this study is to determine the multipathogen profiles and co-detection characteristics among patients with acute respiratory infections (ARIs) in a large district of southern China.MethodsThis multicenter study conducted active surveillance of patients with acute respiratory infections (ARIs) at eight sentinel hospitals in a large district of southern China from August 1; 2024; to December 31; 2025. The study employed multiplex polymerase chain reaction (PCR) technology to screen a series of respiratory specimens for 20 respiratory pathogens. Multi-stage logistic regression models were constructed to assess co-detection associations between pathogens at the individual level.ResultsThe median [interquartile range (IQR)] age of the 6; 199 patients included in the study was 24 [5; 33] years. The detection rate and co-detection rate for any pathogen were 62.5% (3; 876/6; 199) and 18.5% (1; 148/6; 199); respectively. The highest viral detection rate (69.1%; 993/1; 437) was observed in children under five; and the highest bacterial detection rate (47.6%; 487/1; 022) was observed in school-age children. The three most prevalent viral pathogens were identified as rhinovirus (RV); influenza A virus (IAV) and severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The three most prevalent bacterial pathogens were identified as Haemophilus influenzae (H. influenzae); Streptococcus pneumoniae (SPN) and Group A Streptococcus (GAS). The three most prevalent co-detection pairs were SPN with H. influenzae (3.4%; 210/6; 199); RV with H. influenzae (2.8%; 171/6; 199); and RV with SPN (2.0%; 125/6; 199 cases). The detection rates for RV; SARS-CoV-2 and GAS in outpatients were higher than those in inpatients; while the detection rates for RSV; enterovirus (EV); bocavirus (HBoV) and SPN in inpatients were higher than those in outpatients. Virus–virus pairs; such as IAV combined with RV (OR = 0.17; 95%CI: 0.11–0.25) and with RSV (OR = 0.06; 95% CI: 0.02–0.27) exhibited negative co-detection associations. Furthermore; bacteria-bacteria pairs showed positive co-detection associations; such as the combination of SPN and H. influenzae (OR = 2.12; 95% CI: 1.74–2.57).ConclusionThe characteristics of the pathogens vary depending on the patient’s age; the nature of the pneumonia; and the type of medical care sought. Virus-virus pairs showed negative co-detection associations; whereas bacteria-bacteria pairs showed positive co-detection associations.
Keywords:
active surveillance
acute respiratory infections
pathogen profiles
co-detection patterns
co-detection rates
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