Probiotic potential of Tetragenococcus halophilus EFEL7002 isolated from Korean soy Meju.

BACKGROUND: Probiotic starters can improve the flavor profile, texture, and health-promoting properties of fermented foods. Tetragenococcus halophilus is a halophilic lactic acid bacterium that is a candidate starter for high-salt fermented foods. However, the species is known to produce biogenic amines, which are associated with neurotoxicity. Here, we report a probiotic starter strain of T. halophilus, EFEL7002, that is suitable for use in high-salt fermentation. RESULTS: EFEL7002 was isolated from Korean meju (fermented soybean) and identified as T. halophilus, with 99.85% similarity. The strain is safe for use in food as it is a non-hemolytic and non-biogenic amine producer. EFEL7002 is tolerant to gastrointestinal conditions and can adhere to Caco-2 cells. This strain showed antioxidant, anti-inflammatory, and protective effects against the human gut epithelial barrier. EFEL7002 grew well in media containing 0-18% NaCl showing maximum cell densities in 6% or 12% NaCl. CONCLUSIONS: T. halophilus EFEL7002 can be used as a health-promoting probiotic starter culture for various salty fermented foods.

Production of human tissue-type plasminogen activator (htPA) using in vitro cultured transgenic pig mammary gland cells.

Tissue plasminogen activator (tPA) is a protein involved in the breakdown of blood clots. We have previously produced a human tPA (htPA)-overexpressing transgenic pig using a mammary gland-specific promoter. In this study, we have established a transgenic pig mammary gland cell line that produces recombinant htPA. The mammary gland cells grew well and retained their character over long periods of culture. There was no difference in the extent of apoptosis in transgenic cells compared to wild-type mammary gland cells. In addition, the transgenic mammary gland cells expressed and secreted htPA into the conditioned media at a concentration similar to that in milk. This transgenic cell line represents a simple and ethical method for recombinant htPA production.

Immunogenicity and safety of a tetanus-diphtheria vaccine and a 13-valent pneumococcal conjugate vaccine after concomitant vaccination in ≥ 50-year-old adults.

BACKGROUND: When two or more vaccines are administered concurrently, there is concern about safety and immunogenicity from vaccine interaction. METHODS: Subjects aged ≥50 years were randomized 1:1:1 to receive tetanus-diphtheria (Td) + 13-valent pneumococcal conjugate vaccine (PCV13; Group 1), PCV13 alone (Group 2), or Td alone (Group 3). After single or concomitant vaccination, enzyme-linked immunosorbent assay and opsonophagocytic assay (OPA) were performed to compare immunogenicity for Td and PCV13, respectively. RESULTS: A total of 448 subjects were available for the assessment. After concomitant administration, the non-inferiority criteria of geometric mean titer (GMT) ratios were met for tetanus, diphtheria, and all four pneumococcal serotypes (1, 5, 18C, and 19A). However, subjects in Group 3 (Td alone) were more likely to have a high IgG anti-tetanus antibody titer (≥ 0.5 U/mL) than those in Group 1 (Td + PCV13) (p <  0.01). As for the pneumococcal serotype 1, the OPA GMT was significantly higher in Group 1 (PCV13 + Td) compared to Group 2 (PCV13 alone) (p = 0.02). No serious adverse event occurred. CONCLUSIONS: Concomitant Td and PCV13 administration induced sufficient immunity without significant interference and showed good safety profiles. TRIALS REGISTRATION: NCT03552445 registered at http://www.clinicaltrials.gov on June 11, 2018 (retrospectively registered).

Cluster of serogroup W-135 meningococcal disease in 3 military recruits.

We describe a group of 3 cases of invasive meningococcal disease that occurred in a military training camp in April 2011. All three patients were hospitalized. Ultimately, two patients recovered and one died. One patient had meningitis, one patient had septicemia and meningitis, and the other had no definite septicemia or meningitis. Neisseria meningitidis serogroup W-135 was detected in the serum and cerebrospinal fluid (CSF) of all patients by real-time polymerase chain reaction. In the one case of mortality, two strains were isolated from the patient's blood and CSF. Using multilocus sequence typing analysis, these strains were identified as a novel sequence type, ST-8912. Special attention is required for the meningococcal disease in military camp because the military personnels are in high risk of contact transmission.

Lactobacillus gasseri BNR17 and Limosilactobacillus fermentum ABF21069 Ameliorate High Sucrose-Induced Obesity and Fatty Liver via Exopolysaccharide Production and ß-oxidation.

Obesity and metabolic dysfunction-associated fatty liver disease (MAFLD) are prevalent metabolic disorders with substantial global health implications that are often inadequately addressed by current treatments and may have side effects. Probiotics have emerged as promising therapeutic agents owing to their beneficial effects on gut health and metabolism. This study investigated the synergistic effects of a probiotic combination of BNR17 and ABF21069 on obesity and MAFLD in C57BL/6 mice fed a high-sucrose diet. The probiotic combination significantly reduced body weight and fat accumulation compared with the high-sucrose diet. It also alleviated elevated serum leptin levels induced by a high-sucrose diet. Histological analysis revealed a significant reduction in white adipose tissue and fatty liver in the mice treated with the probiotic combination. Furthermore, increased expression of genes related to ß-oxidation, thermogenesis, and lipolysis suggested enhanced metabolic activity. The probiotic groups, particularly the BNR17 group, showed an increase in fecal exopolysaccharides, along with a tendency toward a lower expression of intestinal sugar transport genes, indicating reduced sugar absorption. Additionally, inflammatory markers in the liver tissue exhibited lower expression in the ABF21069 group than in the HSD group. Despite each strain in the combination group having distinct characteristics and functions, their combined effect demonstrated synergy in mitigating obesity and MAFLD, likely through the modulation of fecal exopolysaccharides content and improvement in lipid metabolism. These findings underscore the potential of probiotic supplementation as a promising assistant therapy for managing obesity and MAFLD and provide valuable insights into its therapeutic mechanisms in metabolic disorders.

Clinical and economic burden of invasive pneumococcal disease in adults: a multicenter hospital-based study.

BACKGROUND: Streptococcus pneumoniae causes a broad spectrum of illnesses ranging from mild upper respiratory tract infections to invasive pneumococcal disease (IPD). Quantitative data on the burden of pneumococcal disease, important for the establishment of appropriate vaccination strategies, is currently lacking in adults. METHODS: This multicenter, retrospective cohort study was designed to estimate the clinical and economic burden of IPD in adults over the last decade. Data were collected from patients with IPD at 10 university hospitals in South Korea. We estimated the proportion of IPD among all hospitalized patients, the case fatality rate, and the direct medical costs of IPD. Data were further analyzed according to age and risk groups. RESULTS: During the study period, 970 patients with IPD were identified. The mean age for all patients was 60.9 years; patients aged 50-64 years (33.0%) were most numerous, followed by those aged 65-74 years (27.4%). Overall, the proportion of IPD was 0.36 cases/1000 hospitalized patients and the case fatality rate was 30.9%, which increased significantly with age (p < 0.01). The mean direct medical costs were estimated to be US $7,452 without a difference between age and risk groups. On multivariate analysis, old age, advanced ECOG performance status, bacteremic pneumonia, and nosocomial infection were independent risk factors of 30-day case fatality. CONCLUSIONS: The clinical disease burden of IPD increased significantly with age and direct medical costs from IPD were substantial, regardless of age and co-morbid conditions. The current age-based vaccination strategy appears to be appropriate.

Clinical significance of multidrug-resistant Acinetobacter baumannii isolated from central venous catheter tip cultures in patients without concomitant bacteremia.

BACKGROUND: The purpose of this study was to examine the clinical implications of a positive central venous catheter (CVC) tip culture with multidrug-resistant Acinetobacter baumannii (MRAB) in patients without concurrent bacteremia. METHODS: This retrospective, multicenter study was conducted in 9 teaching hospitals in the Republic of Korea from May 2008 to April 2012. Study subjects included adult patients (aged ≥ 18 y) who yielded an MRAB-positive CVC tip culture without concurrent MRAB bacteremia. All patients were observed for the development of subsequent MRAB bacteremia for 6 months after CVC removal. Multivariable Firth logistic regression analysis was performed to determine predictors independently associated with subsequent MRAB bacteremia. RESULTS: During the study period, subsequent MRAB bacteremia was observed in 18.8% of patients (21/112). Of the 112 patients, 23 (20.5%) did not show systemic inflammatory response syndrome (SIRS). None of the 23 patients without SIRS presented with subsequent MRAB bacteremia. Multivariable logistic regression analysis showed that prior administration of carbapenems (odds ratio (OR) 7.04, 95% confidence interval (CI) 1.43-34.77) or corticosteroids (OR 6.67, 95% CI 1.19-37.44), and C-reactive protein ≥ 40 mg/l (OR 18.11, 95% CI 2.22-148.07) were positive predictive factors. Prior acquisition of MRAB at a site other than the catheter (OR 0.10, 95% CI 0.03-0.39) was a negative predictive factor for developing MRAB bacteremia. CONCLUSIONS: Our results suggest that patients with a CVC tip colonized with MRAB should be closely monitored for signs and symptoms of subsequent MRAB bacteremia.

Phenotypic and genomic analyses of bacteriocin-producing probiotic Enterococcus faecium EFEL8600 isolated from Korean soy-meju.

Enterococcus faecium is a prevalent species found in fermented soybean products, known for its contributions to flavor development and inhibition of pathogenic microorganisms during fermentation. This study aims to provide comprehensive phenotypic and genomic evidence supporting the probiotic characteristics of E. faecium EFEL8600, a bacteriocin-producing strain isolated from Korean soy-meju. Phenotypic analysis revealed that EFEL8600 produced a peptide with inhibitory activity against Listeria monocytogenes, estimated to be 4.6 kDa, corresponding to the size of enterocins P or Q. Furthermore, EFEL8600 exhibited probiotic traits, such as resilience in gastrointestinal conditions, antioxidant and anti-inflammatory activities, and protection of the intestinal barrier. Safety assessments demonstrated no hemolytic and bile salt deconjugation activities. Genomic analysis revealed the presence of several genes associated with probiotic characteristics and bacteriocin production, while few deleterious genes with a low likelihood of expression or transferring were detected. Overall, this study highlights E. faecium EFEL8600 as a potent anti-listeria probiotic strain suitable for use as a starter culture in soymilk fermentation, providing potential health benefits to consumers.

Skin and soft tissue infections: experience over a five-year period and clinical usefulness of ultrasonography-guided gun biopsy-based culture.

BACKGROUND: Skin and soft tissue infections (SSTIs) are common clinical diseases, but only a few reports of microbiological data on SSTIs in Korea have been published. In practice, specimens are rarely obtained from infected lesions unless there is visible pus or an abscess pocket. However, identification of the causative pathogen is important, because of emerging drug resistance and the increase in immunocompromised hosts. METHODS: The medical records of 760 adult cases of community-acquired SSTIs (CA-SSTIs) from September 2003 to August 2008 were reviewed retrospectively. We analyzed epidemio-clinical features and microbiological distributions of CA-SSTIs and evaluated the positive culture rate of several diagnostic methods, including swab, tissue biopsy, blind needle aspiration, ultrasonography (US)-guided needle aspiration, and US-guided gun biopsy. RESULTS: Most CA-SSTIs (76.1%) occurred in previously healthy persons without underlying diseases. Re-infections were identified in 76 (10%) patients and cirrhosis was an independent risk factor for re-infection (odds ratio 3.64, 95% confidence interval 1.36-9.76). The most commonly identified pathogen was methicillin-susceptible Staphylococcus aureus, and 3(rd)-generation cephalosporins were the most commonly used empirical antibiotics (47.9%). US-guided needle aspiration had a high positive culture rate of 73.9% and the positive culture rate of US-guided gun biopsy was 17.5%. CONCLUSIONS: Considering the microbiological distribution of CA-SSTIs in Korea, penicillinase-stable penicillin or a 1(st)-generation cephalosporin should be adequate for initial antibiotic treatment. US-guided needle aspiration was a good technique for the identification of causative pathogens, and additive productivity is expected with US-guided gun biopsy culture from lesions without fluid collection.

Pulmonary and psoas muscle nocardiosis in a patient with lupus nephritis: a case report and review of the literature.

The incidence of nocardiosis is increasing with the expansion of immunosuppressive therapy and improvement of laboratory diagnostic methods. Nocardiosis could be fatal in the compromised host. Some Nocardia species are known to be multi-drug resistant. Thus, early recognition and identification of Nocardia species are important for patient treatment and outcome. Recently, we treated a patient with pulmonary and psoas muscle nocardiosis in a woman taking prednisolone for lupus nephritis; the isolated organism was Nocardia farcinica identified by polymerase chain reaction-restriction fragment length polymorphism testing.

Limosilactobacillus fermentum MG7011: An Amylase and Phytase Producing Starter for the Preparation of Rice-Based Probiotic Beverages.

The goal of this study was to develop a starter strain of Limosilactobacillus fermentum which is beneficial for human health and suitable for rice fermentation. To achieve the goal, the characteristics of 25 strains of L. fermentum were compared in terms of health promoting potentials and rice fermenting abilities. L. fermentum MG7011 was selected as a superior strain to meet the required properties. First, as probiotic traits, the strain had tolerance to gastrointestinal conditions and ability to adhere to Caco-2 and HT-29 cells. The strain showed the antioxidative activity, anti-inflammatory activity, and a protective effect on the epithelial barrier. Next, as starter traits for rice fermentation, MG7011 exhibited proper fermentation profiles in rice solution, such as fast growth rate, pH and metabolite changes, amylase and phytase activities, and optimal viscosity changes for beverage. In conclusion, L. fermentum MG7011 has excellent probiotic activities and proper starter traits in rice, thereby it can be used as a suitable probiotic starter for rice fermentation.

Development of Anti-inflammatory Probiotic Limosilactobacillus reuteri EFEL6901 as Kimchi Starter: in vitro and In vivo Evidence.

The use of probiotic starters can improve the sensory and health-promoting properties of fermented foods. In this study, we developed an anti-inflammatory probiotic starter, Limosilactobacillus reuteri EFEL6901, for use in kimchi fermentation. The EFEL6901 strain was safe for use in foods and was stable under human gastrointestinal conditions. In in vitro experiments, EFEL6901 cells adhered well to colonic epithelial cells and decreased nitric oxide production in lipopolysaccharide-induced macrophages. In in vivo experiments, oral administration of EFEL6901 to DSS-induced colitis mice models significantly alleviated the observed colitis symptoms, prevented body weight loss, lowered the disease activity index score, and prevented colon length shortening. Analysis of these results indicated that EFEL6901 played a probiotic role by preventing the overproduction of pro-inflammatory cytokines, improving gut barrier function, and up-regulating the concentrations of short-chain fatty acids. In addition, EFEL6901 made a fast growth in a simulated kimchi juice and it synthesized similar amounts of metabolites in nabak-kimchi comparable to a commercial kimchi. This study demonstrates that EFEL6901 can be used as a suitable kimchi starter to promote gut health and product quality.

What is the optimal antibiotic treatment strategy for carbapenem-resistant Acinetobacter baumannii (CRAB)? A multicentre study in Korea.

OBJECTIVES: The optimal treatment option for carbapenem-resistant Acinetobacter baumannii (CRAB) is still limited. This study investigated the efficacy of three or more antibiotic types and regimens for treatment of CRAB infection in high CRAB endemic areas. METHODS: A multicentre retrospective study was conducted to evaluate the efficacy of treatment types and regimens of CRAB infections in 10 tertiary hospitals in the Republic of Korea. The outcomes comprised 7-day and 28-day mortality, and clinical and microbiological responses at 7 days, 28 days, and the end of treatment. Nephrotoxicity and hepatotoxicity were evaluated as drug adverse reactions. RESULTS: A total of 282 patients were included in the study. Among the CRAB strains, the two most susceptible antibiotics were colistin (99.6%) and minocycline (80.4%). A combination of colistin and carbapenem significantly reduced 7-day mortality, and a sulbactam-containing regimen significantly reduced 28-day mortality. Colistin monotherapy was significantly associated with increased 7-day and 28-day mortality. A minocycline-containing regimen showed the best microbiological responses at 7 days, 28 days, and the end of treatment. Colistin and tigecycline were associated with increased nephrotoxicity and hepatotoxicity, respectively. Subgroup analysis of patients with pneumonia showed similar results to the overall CRAB infection. CONCLUSIONS: A combination of colistin and carbapenem and sulbactam-containing regimen may contribute improved mortality in CRAB infections. Colistin monotherapy should be considered cautiously in severe CRAB infections or CRAB pneumonia. A minocycline-containing regimen showed the best microbiological responses, and further studies may be needed to evaluate improved mortality.

Seroprevalence of varicella-zoster virus in Korea.

Varicella-zoster virus (VZV) causes chickenpox and herpes zoster. Korea is assumed to have a high seroprevalence of VZV, although data are scant. A cross-sectional and age-stratified study was conducted to investigate the seroprevalence of VZV in different ages in the South Korean population. Four medical institutions were chosen in the southwestern area of Seoul in the vicinity of Gyeonggi-do. Serum samples were obtained at each institution from consenting patients during April-August, 2008. Anti-VZV IgG antibody was measured by an enzyme immunoassay. Of the 887 patients, 87.6% had anti-VZV IgG antibody. The prevalence of anti-VZV IgG antibody was 75% during the first 3 months after birth, but was only 13.6% 12 months after birth. Anti-VZV IgG antibody prevalence increased, first at 1-2 years of age, and then at 5-6 years of age. The seroprevalence rate exceeded 90% in subjects over 11 years of age. The results show that the seroprevalence of VZV is relatively high in the South Korean population. A study on the rate of varicella vaccination and the vaccine's efficacy in South Korea is warranted.

Liver abscess and empyema due to Lactococcus lactis cremoris.

Lactococcus lactis cremoris infections are very rare in humans. We experienced liver abscess and empyema due to L. lactis cremoris in an immunocompetent adult. A 42-yr-old man was admitted with fever and abdominal pain. Abdominal computed tomography (CT) revealed a liver abscess and chest CT showed loculated pleural effusion consistent with empyema. L. lactis cremoris was isolated from culture of the abscess material and blood. The patient was treated with pus drainage from liver abscess, video-assisted thoracoscopic decortications for empyema, and antibiotics including cefotaxime and levofloxacin. The patient was completely recovered with the treatment. To our knowledge, this is the first report of a L. lactis cremoris infection in Korea.

Lactobacillus pentosus SMB718 as a probiotic starter producing allyl mercaptan in garlic and onion-enriched fermentation.

Fermenting garlic and onion provides the advantages of storage life extension, anti-oxidative and anti-diabetic activities, and their metabolite, allyl mercaptan, offers a strong aroma and various health benefits. Here, we report the probiotic properties of Lactobacillus pentosus SMB718 isolated from Korean traditional paste and its high allyl mercaptan productivity in garlic and onion fermentation. This strain was safe for use in food fermentation, as it was a non-biogenic amine producer and non-hemolytic. It showed high stability under simulated human gastrointestinal conditions and good adhesion ability to intestinal epithelial cells, including both Caco-2 and HT-29. This strain had antioxidant and anti-microbial activities. In addition, the heat-killed cells and lysate exerted anti-inflammatory effects on both LPS-stimulated RAW 264.7 cells and mouse macrophages by inhibition of pro-inflammatory cytokines and induction of anti-inflammatory cytokines. Furthermore, this strain possessed good fermentation properties in garlic and onion-enriched radish juice (GORJ); it grew well decreasing the pH and provided a rich aroma compound during fermentation. When L. pentosus SMB718 was used as a starter in garlic and onion fermentation, a significantly higher amount of allyl mercaptan (344 ppb) was produced compared with that produced by the type strain (82 ppb). In conclusion, L. pentosus SMB718 can be used as a beneficial probiotic starter for better flavor production in the fermentation of allium species plants.

The clinical and economic burden of community-onset complicated skin and skin structure infections in Korea.

BACKGROUND/AIMS: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea. METHODS: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea. RESULTS: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson's comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality. CONCLUSION: Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.

Dose sparing strategy with intradermal influenza vaccination in patients with solid cancer.

Influenza vaccine is considered to reduce influenza-related morbidity and mortality in patients with underlying chronic medical conditions. Because of fear of vaccine shortage during an influenza pandemic, several antigen sparing strategies have been investigated. The immunogenicity of intradermal influenza vaccination with one half the antigenic contents was compared to that of conventional intramuscular vaccination in patients with solid cancer, and adverse events were assessed after vaccination. There was no significant difference between the injection routes in the hemagglutinin inhibition (HI) response and increase in the titer of A/H1N1, A/H3N2, and B 4-6 weeks after the vaccination; seroconversion factors increased by more than 2.5-fold. Seroresponse rates were more than 40% and seroprotection rates were above 70% against all three influenza strains irrespective of the vaccination routes. No serious events were observed, and local skin reactions were more frequent in the intradermal injection recipients than in the intramuscular recipients (32.7% vs. 9.1%). This study shows that intradermal injection of one half the dose of a commercial influenza vaccine elicits immune responses comparable to those elicited by a full dose of intramuscular vaccine among cancer patients, and it can be tolerated without serious adverse reactions.

Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group.

OBJECTIVES: This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). METHODS: Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. RESULTS: A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. CONCLUSIONS: This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.

Disease burden of hospitalized community-acquired pneumonia in South Korea: Analysis based on age and underlying medical conditions.

Pneumonia is a leading cause of hospitalization and mortality worldwide. Despite recognition of the importance of community-acquired pneumonia (CAP) in adults, limited epidemiologic information is available in South Korea. This study aimed to evaluate the disease burden of hospitalized CAP in adults aged ≥19 years and its epidemiologic trend using Health Insurance and Review Assessment (HIRA) data.This is a retrospective study using the HIRA database from year 2009 to 2013. We estimated the incidence rate and direct medical cost of hospitalized CAP in adults aged ≥19 years in South Korea. These were further analyzed with respect to age and underlying medical conditions.During 2009 to 2013, 1216,916 hospitalizations were recorded. On average, the annual age-adjusted incidence rate of hospitalized CAP was 626 per 100,000 persons, with the rate increasing with age. When stratified by age- and risk groups, elderly people ≥75 years showed the highest incidence rate of hospitalized CAP over 5-year study periods. With respect to the risk groups based on underlying medical conditions, incidence rate ratios were 2.04 to 5.86 for the high-risk group versus the low-risk group and 1.28 to 5.49 for the moderate-risk group versus the low-risk group. Overall, mean direct medical cost for hospitalized CAP was 1851 USD per capita during the 5-year period: 1263 USD in the low-risk group, 2353 USD in the moderate-risk group, and 2841 USD in the high-risk group.This study shows that the incidence and medical cost of hospitalized CAP were consistently high over the 5-year study period. In particular, elderly people and adults with underlying medical conditions were at increased risk for hospitalized CAP.