Pseudomonas aeruginosa bacteremia in cancer patients develops from initial gastrointestinal (GI) colonization with translocation into the bloodstream in the setting of chemotherapy-induced neutropenia and GI mucosal damage. We established a reproducible mouse model of P. aeruginosa GI colonization and systemic spread during neutropenia. Mice received 2 mg of streptomycin/ml of drinking water and 1,500 U of penicillin G/ml for 4 days and then ingested 10 7 CFU of P. aeruginosa per ml of drinking water for 5 days. After GI colonization levels were determined, cyclophosphamide (Cy) was then injected intraperitoneally (i.p.) three times every other day or an antineutrophil monoclonal antibody, RB6-8C5, was injected i.p. once. Dissemination was defined by the presence of P. aeruginosa in spleens of moribund or dead mice. In this mouse model, P. aeruginosa colonizes the GI tract and then disseminates systemically once Cy or RB6-8C5 is administered. The duration and intensity of neutropenia, related to Cy dose, was found to be a means to compare the virulence of different P. aeruginosa strains, as exhibited by comparisons of strains lacking or producing the virulence-enhancing ExoU cytotoxin. The lipopolysaccharide outer core polysaccharide and O side chains were critical in establishing GI colonization, and P. aeruginosa mutants lacking the aroA gene (necessary for synthesizing aromatic amino acids) were able to establish GI colonization but unable to disseminate. Both the colonization and dissemination phases of P. aeruginosa pathogenesis can be studied in this model, which should prove useful for evaluating pathogenesis, therapies, and associated means to control P. aeruginosa nosocomial infections.Pseudomonas aeruginosa causes significant morbidity and mortality in immunocompromised hosts (1, 15, 44), particularly neutropenic cancer patients (16). Although currently gram-positive organisms account for 60 to 70% of all documented infections in febrile neutropenic cancer patients (17, 26), these infections, in general, are typically more indolent, and delays of 24 to 48 h in initiating antibiotic therapy are usually not detrimental (17, 46). Importantly, the incidence of P. aeruginosa bacteremia has decreased in solid tumor patients but not in patients with acute leukemia (8). In fact, despite its lower incidence, P. aeruginosa continues to cause a disproportionate degree of morbidity and mortality in this patient population (6, 15, 16).The presumed mechanism for establishing P. aeruginosa bacteremia in cancer patients involves initial gastrointestinal (GI) colonization with subsequent translocation into the bloodstream in the setting of chemotherapy-induced neutropenia and GI mucosal damage (39). Leukemia patients who develop P. aeruginosa bacteremia have been found to have fecal cultures that are positive for the same strain of P. aeruginosa (18,50). When fecal cultures of these patients showed the presence of other potentially pathogenic gram-negative organisms (e.g., Escherichia coli, Klebsiella sp., etc.), P. ae...