Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity, however there are scarce data about their implication in respiratory failure.We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host- and pathogen-related factors associated with respiratory failure.Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 vs. 55.4, p<.001) and had a greater proportion of co-morbid conditions. They also had a greater proportion of septic shock (41.7% vs. 6.1%, p<.001), required more often ICU admission (38.4% vs. 4.2%, p<.001) and had a higher mortality (25.5% vs. 3.5%, p<.001). After adjustment, independent risk factors for respiratory failure were: age >50 years (OR 1.63; 95% CI, 1.15-2.3), chronic lung disease (OR 1.54; 95% CI, 1.1-2.15), chronic heart disease (OR 1.49; 95% CI, 1.01-2.22) infection caused by serotypes 3 (OR 1.97; 95% CI, 1.23-3.16), 19A (OR 2.34; 95% CI, 1.14-4.42) and 19F (OR 3.55; 95% CI, 1.22-10.28).In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication.