In France, surveillance of infections caused by Shiga toxin-producing Escherichia coli (STEC) is based on the surveillance of post-diarrheal hemolytic uremic syndrome (HUS) in children under 15 years of age, which was established in 1996. After eight years of operation, this surveillance system was evaluated to assess its relevance and make any necessary modifications. In addition to this evaluation, and given the epidemic potential of STEC infections, it was suggested that the feasibility of expanding HUS surveillance to include other STEC-related conditions—particularly bloody diarrhea—be studied. To contribute to the discussion on the feasibility and modalities of such surveillance, a survey—following one already conducted in 1997—was carried out among 927 biological and medical testing laboratories, comprising all 418 hospital laboratories and a sample of 509 randomly selected private laboratories. This survey, which consisted of sending a standardized questionnaire to each of the selected laboratories, aimed to compile an inventory of the various routine testing methods for enteropathogenic E. coli (EPEC) and enterohemorrhagic E. coli (EHEC), to estimate the number of tests performed in 2003 and the number of positive results, and to determine the reasons why these tests are rarely or never performed. Of the 357 (39%) laboratories that participated in the survey (192 hospital laboratories and 165 private laboratories), 215 (60%) performed testing for EPEC or EHEC. A majority of them (66%) perform these tests at the clinician’s request or routinely for all stool cultures, and especially in cases of diarrhea in children under 2 years of age. Testing for E. coli O157 is most frequently performed in cases of bloody diarrhea in children or in cases of HUS (55–60%). However, only 36% of laboratories reported having tested for E. coli O157 in 2003. Sixteen laboratories (all hospital-based) characterize the virulence of EHEC strains by PCR testing for genes encoding Shiga toxins, and only 39% of laboratories submit serum samples to the National Reference Center (NRC) for E. coli and Shigella for serodiagnosis of EHEC infections. The main reasons cited by laboratories not testing for EPEC or EHEC were the unavailability and lack of familiarity with the techniques, limited knowledge regarding the significance of EHEC infections in humans, and the absence of specific requests from clinicians. In conclusion, this survey reveals that testing for EPEC or EHEC remains uncommon in France, due to the rarity of STEC infections outside of HUS, and the unavailability and complexity of the techniques required to fully identify an STEC. Given these results, and given the current state of EPEC and EHEC testing practices, a national surveillance system for STEC infections, based on a representative network of laboratories, is therefore not yet feasible. However, this study has identified specific actions (development of an STEC detection protocol, technical support for laboratories) to improve the diagnosis of STEC infections. These actions will be implemented in collaboration with the CNR for E. coli and Shigella and the laboratory associated with the CNR. (R.A.)