Since joining the Centers for Disease Control and Prevention's (CDC) Foodborne Diseases Active Surveillance Network (FoodNet) in 1999, Tennessee has conducted active surveillance for foodborne pathogens including Shiga toxin-producing E. coli (STEC). The number of STEC infections has increased in recent years in the United States, including Tennessee, due partly to changes in clinical laboratories practices including non-culture based testing methods. Despite increased reporting, STEC infections are likely under-recognized in Tennessee. A 2007 statewide laboratory survey indicated that less than half of clinical laboratories test for STEC on-site. Among these, only nine reported using non-culture based methods. Only one clinical laboratory reported simultaneous culture for STEC O157 and testing with an assay that detects Shiga toxins for non-O157 STEC as recommended by the CDC. Adoption of CDC recommendations coupled with timely and complete reporting will enhance public health surveillance, outbreak investigations and interventions to prevent STEC infection.