Infectious diseases are characterized by acute onset and rapid progression, and the efficiency of their diagnosis and treatment is highly dependent on the timeliness and accuracy of microbiological testing. Focusing on shortening turnaround time and improving result precision, this paper systematically reviews the evolution of microbiological testing across three stages: manual microscopic examination and conventional culture, automated biochemical identification, and mass-spectrometry-based and molecular diagnostics. It summarizes the breakthroughs and limitations of representative technologies in each stage, analyzes the impacts of technological iteration on clinical decision-making, specimen submission practices and antimicrobial stewardship, and prospects future trends including full-process automation, point-of-care testing, and multi-omics integration.