Genetic relatedness of 100 strains of Escherichia coli, isolated mostly from patients with hemorrhagic colitis or hemolytic uremic syndrome, was determined for chromosomal genotypes on the basis of allelic variation at 17 enzyme-encoding loci detected by multilocus enzyme electrophoresis. Fifteen of the 17 loci were polymorphic, with an average of 3.5 alleles per locus. Comparison of the observed combinations of alleles among strains revealed 25 distinct multilocus genotypes, which were used to define naturally occurring cell lineages or clones. Cluster analysis of the genotypic data revealed that isolates of serotype O157:H7 fall into a well-defined group of clonal genotypes that share alleles, on average, at 90% of their enzyme loci. The O157:H7 clonal group is only distantly related to other Verotoxin-producing strains belonging to other serotypes of E. coli. The results strongly support the hypothesis that isolates of E. coli O157:H7 obtained from geographically separate outbreaks and sporadic cases of hemorrhagic colitis and hemolytic uremic syndrome belong to a pathogenic clone that occurs throughout North America.