Recently, there have been increasing numbers of pneumococcal pneumonia cases, with their associated complications. We conducted a retrospective review to increase the understanding of childhood pneumococcal pneumonia. Seventy-one patients with pneumococcal pneumonia were identified. Forty (56.3%) of them developed complicated pneumonia. Multivariate analysis showed that presence of immature polymorphonuclear leukocytes in peripheral blood (odds ratio [OR], 3.67; 95% confidence interval [CI],

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... 8-12.63), high Creactive protein levels (112 mg/dL) (OR, 5.24; 95% CI, 1.10-24.93), and no underlying disease at presentation (OR, 5.48; 95% CI, 1.06-28.25) were independent predictors of the occurrence of necrosis or/and abscess. Fourteen isolates (35%), which were genotypically identical and had the same pulsed-field gel electrophoresis pattern (serogroup 14, with MICs of penicillin of 0.1-0.5 mg/mL), were significantly associated with complicated pneumonia ( ). Whether the virulence of antibiotic-resistant pneumococci is evolving deserves further P p .047 investigation. Streptococcus pneumoniae is the most common pathogen of pyogenic pneumonia in children [1] . The critical issues concerning S. pneumoniae in recent decades are the global emergence of multidrug-resistant pneumococci and the high carriage rate of penicillin-nonsusceptible S. pneumoniae (PNSP) among children [2] [3] [4] . There are many reports that address the impact of PNSP. The majority of these studies conclude that there is no difference in the clinical characteristics of and outcomes for pneumonic patients infected with penicillin-susceptible S. pneumoniae or PNSP [5, 6] . Only 1 retrospective study, which was performed in Atlanta, demonstrated a significant risk of suppurative complications among adults with pneumococcal pneumonia who were infected with PNSP strains [7] . We know from experience that pneumonia caused