A collection of 222 isolates of Pseudomonas aeruginosa was obtained from the respiratory tract of 16 patients with cystic fibrosis over a 4to 9-month period. Fourteen of these patients were unrelated, while the remaining two were siblings. Isolates were typed by conventional pyocin typing and also by the use of a DNA probe containing 741 bp immediately upstream of the exotoxin A structural gene and the initial 732 bp of the exotoxin A structural gene. By pyocin typing, 69% (11 of 16) of the patients were shown to harbor a single type that persisted in the lung throughout the study. By genotyping (DNA probe typing), all but three patients (13 of 16, 81%) harbored a single persistent genotype in their lungs. Six patients other than the sibling pair (6 of 14, 43%) shared a common genotype in their lungs as judged by DNA probing, and the pyocin type of these isolates was also identical. In four of these six patients, the shared genotype was also the persistent genotype. The sibling pair studied also carried a common genotype in their lungs as indicated by DNA probing, even though the pyocin type of these isolates varied. Results presented suggest that the majority of patients harbor a persistent strain in their lungs and that cross-colonization may occur. Pseudomonas aeruginosa is the predominant bacterium associated with pulmonary infection in cystic fibrosis (CF) patients (6, 29). The organism persists in the airways of CF patients despite intensive antibiotic therapy and contributes to pulmonary failure, which is the major cause of morbidity and mortality in CF patients (9). Strains of P. aeruginosa colonizing the lung in CF are unique in their sensitivity to serum (6, 16, 24), presence of rough outer membrane lipopolysaccharide (5), ability to polyagglutinate in 0 antisera, and tendency to produce alginate exopolysaccharide. Understanding the epidemiology of P. aeruginosa colonization of the CF respiratory tract has been hampered due to the predominance of polyagglutinable or nontypeable strains of P. aeruginosa from CF in conventional 0-antigen serotyping reactions (13). Other conventional typing methods such as phage typing and pyocin typing have poor discriminative powers (18) or poor reproducibility (20), respectively. However, the DNA probe to the upstream region of the exotoxin A gene developed by Vasil et al. (27) has been shown to give good discrimination and reproducibility when used to type P. aeruginosa of CF origin (12). A probe similar to that used by Ogle et al. (12) was used in combination with pyocin typing in the present study. Our results confirm earlier studies (8, 12, 14, 23, 28) that suggest carriage of a persistent genotype within the lungs of CF patients. This study also presents results that suggest that cross-or coinfection may occur in nonrelated patients. MATERIALS AND METHODS Patient group. Sixteen children attending the CF clinic, Royal Children's Hospital, Brisbane, Australia, and ranging in age from 6 to 19 years were studied. Sputum specimens were collected from the patients at hom...