Analysis of the pathogen spectrum, co-infection characteristics, and risk of severe disease in community-acquired pneumonia among children in Henan province.

OBJECTIVE: To analyze the pathogen spectrum, co-infection characteristics, and risk factors for severe pneumonia in children with community-acquired pneumonia (CAP) in Henan Province. METHODS: This study included 2,149 pediatric inpatients with CAP admitted to the Third Affiliated Hospital of Zhengzhou University from June 2023 to June 2025. Throat swab samples were tested using multiplex polymerase chain reaction (PCR) for 11 respiratory pathogens. Combined with culture results, the pathogen spectrum and co-infection characteristics were analyzed, and risk factors for severe pneumonia were identified using multivariate logistic regression analysis. It should be noted that a positive throat-swab PCR result cannot unambiguously differentiate pathogenic infection from colonization, prior infection, or asymptomatic carriage; this inherent limitation was taken into account during data interpretation. RESULTS: The overall pathogen detection rate was 89.34%, with Mycoplasma pneumoniae (31.55%) and rhinovirus (31.13%) predominating; among bacteria, Haemophilus influenzae (3.77%) and Streptococcus pneumoniae (3.35%) were the most common. Except for influenza B virus and human coronavirus, significant differences were observed in the age distribution of each pathogen (P < 0.05). The detection rate of M. pneumoniae increased significantly with age, reaching 58.5% in school-aged children. Rhinovirus was active throughout the year (peaking at 65.14% in October 2024), while M. pneumoniae had the highest detection rate in October 2023 (65.93%). The overall co-infection rate was 31.07%, consisting primarily of virus-virus or virus-atypical pathogen combinations (21.49%), with rhinovirus-M. pneumoniae being the most common (8.52%). Independent risk factors for severe pneumonia were underlying medical conditions (OR = 4.031) and a history of preterm birth (OR = 3.544), whereas co-infections with viruses or atypical pathogens, or concurrent bacterial infections, did not significantly increase the risk of severe disease. CONCLUSION: From June 2023 to June 2025, the pathogen spectrum of CAP in children in Henan Province was dominated by M. pneumoniae and rhinovirus (though HRV positivity should be interpreted with caution given its high asymptomatic carriage rate), with a distinct age distribution. Underlying medical conditions and a history of preterm birth were the primary risk factors for severe pneumonia.