One hundred thirty-four consecutive cases of pneumococcal bacteremia observed during a six-year period were evaluated. One hundred nineteen (89%) were associated with pneumonia. Factors associated with increased mortality were advanced age, a leukocyte count at admission of less than 5,000/cu mm, neoplastic disease, and involvement of two or more pulmonary lobes in patients with pneumonia. Mortality was 30.5% overall, and 76% in patients admitted to the intensive care unit with pneumococcal bacteremia. Pneumococcal infection continues to be an important cause of morbidity and mortality despite modern supportive care and antimicrobial therapy. © 1983, American Medical Association. All rights reserved.