Objective To understand serotypes and clinical manifestation of children with invasive pneumococcal disease (IPD) in Suzhou, so as to find a better strategy for reducing the incidence and mortality of IPD. Methods Eighty children with IPD were enrolled into our study from January 2011 to December 2015.The data of epidemiology, serotype, clinical manifestation, laboratory results and prognosis were collected and analyzed. Results The mortality of 80 children with IPD was 17.5%(14/80). Sixty percent of them were younger than 2 years old, and 78.6% of 14 dead cases were younger than 2 years old, the median age of dead group 0.68 (0.45, 2.07) years was younger than 1.61 (0.85, 3.45) years of survival group (P 0.05). The drug resistance rates of 80 pneumococcus to Erythromycin, Clindamycin, Tetracycline, Sulfamethoxazole, Penicillin, Cefotaxime, Amoxicillin, Chloramphenicol, Vancomycin and Levofloxacin were 100% (80/80), 98.8% (79/80), 88.8%(71/80), 71.3%(57/80), 48.8%(39/80), 32.5%(26/80), 8.8%(7/80), 5.0%(4/80), 0(0/80) and 0(0/80) respectively.Eight serotypes of 80 IPD cases were listed in descending order: 6B(25.5%, 20/80), 14(23.8%, 19/80), 19F(15.0%, 12/80), 19A(15.0%, 12/80), 23F(8.8%, 7/80), 20(5.0%, 4/80), 9V(5.0%, 4/80) and 15B/C(2.5%, 2/80), and 6 serotypes of 14 dead cases were: 6B(35.7%, 5/14), 14(28.6%, 4/14), 19F(14.3%, 2/14), 19A(7.1%, 1/14), 23F(7.1%, 1/14) and 20(7.1%, 1/14); the coverage of IPD serotypes of 7-valent pneumococcal conjugate vaccine (PCV7) 77.5%(62/80) was lower than 92.5%(74/80) of 13-valent pneumococcal conjugate vaccine (P<0.05). Conclusion Majority of dead cases of IPD is always younger than 2 years.The low coincidence rate of choices of antibiotics to invasive pneumococcus outpatient and low rate of PCV immunization in China are responsible for the high mortality of IPD.Timely recognition of continuous hyperpyrexia, vomiting and somnolence in early stage and appropriate use of antibiotics is the key to improve the outcome of IPD.Thirteen-valent pneumococcal conjugate vaccine immunization provides a robust strategy for reducing the incidence and mortality of IPD. Key words: Pneumococcus; Serotype; Invasive disease; Dead; Drug resistance,