Background: Severe acute respiratory infection (SARI) is an important health issue,which was broadly impacted by COVID-19 pandemic. However, changes of epidemic trends and characteristics involving multiple respiratory pathogens are not well defined.This study aimed to characterize the circulation patterns of common respiratory pathogens before, during, and after the pandemic. Methods: The retrospective observational multi-center study was conducted at seven sentinel hospitals in Shanghai,China from 2019 to 2023. Patients with SARI aged 15 years and older were tested for 12 respiratory pathogens (22 subtypes) using real-time polymerase chain reaction. Results: Of the 4738 patients tested,the positive rate of the pathogens decreased from the pre-pandemic year to the pandemic years by 45.47% (from 30.26% to 16.50%), and then increased by 21.64% (from 16.50% to 20.07%) in the post-pandemic year. The change of each pathogen showed four different patterns: (1) decreased first and then increased (IFV, M. pneumoniae, B. pertussis, HBoV); (2) continuing decreased (HPIV, HCoV, HAdV, EV/HRV, L. pneumophila); (3) increased first and then decreased (HMPV); (4) continuing increased (RSV). Among the three periods, IFV, EV/HRV, and HCoV remained stay on the top five positions of the spectrum, M. pneumoniae was the top pathogen found among 15-44 years of age (33.65%). Varied seasonality was observed among patients with SARI. The co-infection rates of the SARI patients were 1.14% (54/4738), of which mixed infection of IFV and M. pneumoniae was most common (20.37%). Conclusions: Circulation patterns of the common respiratory pathogens changed from 2019 to 2023. It is necessary to be alert to outbreak or epidemic of certain pathogens, as well as strengthening the surveillance for the risk of co-epidemic of multiple respiratory pathogens.