Streptococcus pneumoniae bacteremia was diagnosed in 33 patients between June 1999 and November 2000 at the Chang Gung Memorial Hospital-Kaohsiung in southern Taiwan. Antimicrobial susceptibility and serotyping of the clinical isolates were performed. Pneumonia was diagnosed in 19 patients, primary bacteremia in 13, and meningitis in one. The most common serotypes were types 14, 3, and 23F. Fourteen (42.4%) isolates of S. pneumoniae were non-susceptible to penicillin. High antimicrobial resistance rates were found to erythromycin (81.9%), tetracycline (69.7%), clindamycin (69.7%), trimethoprim-sulfamethoxazole (33.1%), and chloramphenicol (12.1%). The mortality was 42.4% and liver cirrhosis was an independent risk factor for mortality (odds ratio = 9.998; 95% confidence interval, 1.011-98.85; p=0.049). All isolated strains were covered by 23-valent the pneumococcal vaccine. Given the increasing prevalence of penicillin non-susceptible S. pneumoniae infection in the community, ongoing periodic monitoring of the evolutionary clinical situation is needed. Results of this study suggest that patients with liver cirrhosis should be inoculated with pneumococcal vaccine.