Objective: To delineate the pathogen spectrum and epidemiological features of acute respiratory infections (ARI) among pediatric patients in Beijing during 2024-2025. Methods: In this cross-sectional study, 1 435 children diagnosed with ARI were enrolled from outpatient, emergency, respiratory medicine, and critical care medicine department of Capital Center for Children's Health, Capital Medical University between July 2024 and June 2025. Respiratory specimens were collected and screened for 28 respiratory pathogens using multiplex real-time quantitative PCR. Specimens positive for influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and human rhinovirus were further subtyped. Patients were categorized into influenza-like illness (ILI) and severe acute respiratory infection (SARI) groups. Positivity rates across different sources, visit periods, and age groups were compared using the chi-square test and Wilcoxon rank-sum test. Results: Among the 1 435 children, there were 770 males and 665 females, with an age at presentation was 6.7 (4.4, 12.6) years. The total positive rate for the 28 pathogens was 80.5% (1 155/1 435). The ILI group comprised 1 040 cases (549 males, 491 females) with age at presentation was 6.8 (4.5, 12.8) years and the positive rate of 76.6% (797/1 040). Common viral pathogens included human rhinovirus 15.7% (163/1 040), human parainfluenza-virus (HPIV) 10.3% (107/1 040), and Influenza virus 7.1% (74/1 040), while common bacterial and atypical pathogens included Mycoplasma pneumoniae (MP) 18.7% (194/1 040), Haemophilus influenzae (HI) 18.4% (191/1 040), and Streptococcus pneumonia (SP) 17.1% (178/1 040). The SARI group comprised 395 cases (221 males, 174 females) with age at presentation was 6.5 (4.0, 12.3) years and the positive rate of 90.6% (358/395). Common viral pathogens included human rhinovirus 17.2% (68/395), RSV 9.9% (39/395), and HPIV 7.1% (28/395), while common bacterial and atypical pathogens included MP 51.4% (203/395), SP 15.4% (61/395), and HI 13.4% (53/395). Co-detections of multiple pathogens accounted for 43.0% (497/1 155) of all positive cases. The positivity rates of RSV and MP in the SARI group were significantly higher than those in the ILI group (both P<0.001). RSV positive rate was the highest in children under 1 year of age, accounting for 15.3% (13/85), while MP positive rate was the highest in children aged 7 to 18 years, accounting for 38.1% (205/538). Typing results revealed that 96.5% (83/86) were typed to H1N1 among influenza virus A cases, while 58.3% (42/72) were genotyped as RSV-A ON1 among RSV cases, 86.3% (63/73) were subtyped to B2 among HMPV cases, and 45.0% (104/231) were typed to human rhinovirus-A among human rhinovirus cases. Conclusion: The pathogen spectrum of pediatric patients with ARI in Beijing from 2024 to 2025 was characterized by the alternation or co-circulation of multiple bacteria and viruses, a high rate of co-detection of multiple pathogens, and different between SARI and ILI groups. Influenza virus was dominated by H1N1, RSV by RSV-A, HMPV by HMPV-B2, and human rhinovirus by human rhinovirus-A. 目的: 分析2024—2025年北京地区儿童急性呼吸道感染(ARI)病原谱及各病原流行特征。 方法: 横断面研究,纳入2024年7月至2025年6月就诊于首都医科大学附属首都儿童医学中心门急诊、呼吸内科、重症医学科的1 435例ARI患儿,收集患儿呼吸道标本,应用多重实时荧光定量PCR进行28种呼吸道病原体检测,其中流感病毒、呼吸道合胞病毒(RSV)、人偏肺病毒(HMPV)、鼻病毒阳性样本进一步分型。根据临床诊断分为流行性感冒样病例(ILI)组及严重急性呼吸道感染(SARI)组。采用χ2检验和Wilcoxon秩和检验比较不同来源、不同就诊时间、不同年龄患儿的各病原检出差异。 结果: 1 435例患儿中,男770例、女665例,就诊年龄6.7(4.4,12.6)岁,28种病原总阳性检出率为80.5%(1 155/1 435)。ILI组1 040例,男549例,女491例,就诊年龄6.8(4.5,12.8)岁,阳性检出率76.6%(797/1 040),常见病毒病原有鼻病毒15.7%(163/1 040)、副流感病毒(HPIV)10.3%(107/1 040)、流感病毒7.1%(74/1 040),常见细菌及非典型病原体有肺炎支原体(MP)18.7%(194/1 040)、流感嗜血杆菌(HI)18.4%(191/1 040)、肺炎链球菌(SP)17.1%(178/1 040)。SARI组395例,男221例、女174例,就诊年龄6.5(4.0,12.3)岁,阳性检出率90.6%(358/395),常见病毒病原有鼻病毒17.2%(68/395)、RSV 9.9%(39/395)、HPIV 7.1%(28/395),常见细菌及非典型病原体有MP 51.4%(203/395)、SP 15.4%(61/395)、HI 13.4%(53/395)。多病原混合检出病例占总阳性病例的43.0%(497/1 155)。SARI组RSV及MP阳性检出率均高于ILI组(均P<0.001)。RSV在<1岁患儿中检出率最高,占15.3%(13/85),MP在7~18岁患儿中检出率最高,占38.1%(205/538)。流感病毒中甲型流感H1N1病毒(H1N1)96.5%(83/86)、RSV中A亚型ON1基因型58.3%(42/72)、HMPV中B2亚型86.3%(63/73)、鼻病毒中A组 45.0%(104/231)。 结论: 2024—2025年北京地区儿童ARI病原谱呈现多种细菌与病毒交替或混合流行的特征,有较高的混合检出。SARI组与ILI组病原谱存在差异。流感病毒H1N1、RSV中A亚型、HMPV中B2亚型、鼻病毒A组为主。.