Objective <p>To analyze the etiology and epidemiological characteristics of respiratory infections during the winter season in the Tengzhou region and provide localized data to support public health measures.</p> Methods <p>A retrospective study was conducted on patients diagnosed with acute upper respiratory tract infections (ARTIs) between November 2023 and January 2024 at Tengzhou Central People's Hospital and Tengzhou Maternal and Child Health Hospital. Pathogens analyzed included influenza A (Flu A), influenza B (Flu B), respiratory syncytial virus (RSV), adenovirus (ADV), <i>Mycoplasma pneumoniae</i> (MP), and human rhinovirus (HRV). Statistical analyses were performed to evaluate infection patterns and their associations with age and other variables.</p> Results <p>A total of 4,869 specimens were collected, with 2,307 cases (47.4%) identified as single- pathogen infections, 272 cases (10.9%) as dual-pathogen infections, and 37 cases (1.5%) as infections with three or more pathogens. The detection rates differed significantly between the &lt; 14-year-old and ≥ 14-year-old groups (χ² = 13.87, <i>P</i> &lt; 0.05). Flu A was the most frequently detected pathogen (1,340 cases, 27.5%), followed by RSV (251 cases, 10.1%), ADV (241 cases, 9.7%), MP (223 cases, 4.6%), HRV (113 cases, 4.5%), and Flu B (139 cases, 2.9%). Detection rates for these six pathogens varied significantly between the &lt; 14-year-old and ≥ 14-year-old groups (<i>P</i> &lt; 0.05). Among the 1,340 Flu A-positive cases, 543 (40.5%) were H3N2-positive, accounting for 11.2% of all specimens. One H1N1 case was detected, co-infected with H3N2, and no H7N9 cases were found.</p> Conclusions <p>This regional surveillance study highlights age-related differences in respiratory pathogen circulation in Tengzhou during the winter season. The findings support the need for continued seasonal monitoring and targeted prevention efforts.</p>