Despite infection control efforts, bacteraemia remains one of the most frequent and challenging hospital-acquired infections and is associated with high attributable morbidity and mortality and additional use of healthcare resources. Prevention and control of hospital-acquired blood-stream infection requires improved detection methods, better definition of patient populations at risk, more refined guidelines for the interpretation of positive blood cultures and a better discrimination between sporadic contaminants and true bacteraemia. These issues are addressed in the current review together with those related to the diagnosis, management and recent advances in the prevention of cathether-related bacteraemia, the leading cause of hospital-acquired blood-stream infection. Finally, the reasons and perspectives for blood-stream infection surveillance are briefly discussed.