Among patients whose samples were cultured after a positive rapid test, 59 percent yielded a result in 2024, compared with 71 percent in the earlier baseline. Only 7,314 of those, or 79 percent, had a positive culture, and only 6,066 isolates were fully serotyped. For Shiga toxin-producing E. coli, the gap is far wider: 3,635 infections reported, but just 1,373 with a positive culture result. The central uncertainty is how much of the recent rise in reported infections reflects better detection rather than more disease. Perform a follow-up culture after a positive rapid test result, and ask test developers to design panels that remain compatible with culture-based methods.