In recent years, bacterial infectious diseases have been occurring, and the frequent use of antibiotics has led to a significant increase in the number of drug-resistant bacteria, and the phenomenon of drug resistance is becoming more and more serious. There is an urgent need for an efficient and accurate detection technology to make a judgment on the pathogenic bacteria. Different species of bacteria have different molecular compositions and structures. Surface-enhanced Raman spectroscopy (SERS) is used to distinguish and reflect the cellular state mainly due to its ability to reflect the unique spectral fingerprint of bacteria. The detection of pathogenic bacteria by SERS is influenced by several factors, and this paper introduces three aspects of SERS detection of pathogenic bacteria and provides a brief review. Firstly, the design of substrates is summarized in terms of different structures and sizes of SERS substrates for pathogenic bacteria. Secondly, the co-culture, in situ reduction and electrostatic binding of pathogenic bacteria for non-labeling detection and labeling detection including external and internal labeling methods for SERS detection of pathogenic bacteria are reviewed. Finally, the identification of pathogenic bacteria is combined with the traditional multivariate statistical analysis method of Raman spectroscopy of pathogenic bacteria and advanced machine learning algorithms, and the application of SERS in pathogenic bacteria detection is summarized and prospected.