In our clinical practice, we often see patients with cirrhosis who are admitted to the hospital because of various infections. Many patients with cirrhosis require emergency or elective endoscopic treatment (sclerotherapy, ligation or tissue adhesive treatment) for esophagogastric varices, and endoscopic treatment increases the risk of infection and aggravates existing infections. Patients with decompensated cirrhosis have high frequency of infection and heavy disease, and are prone to induce hepatic encephalopathy, hepatorenal syndrome, etc., even causing death. According to statistics, bacterial infections in patients with decompensated cirrhosis increase the morbidity and mortality rate by 3.75 times, and the morbidity and mortality rates at 1 month and 1 year reach 30% and 63%, respectively. Once an infection occurs, it is like adding insult to injury for patients with cirrhosis, however, many patients and their families do not pay enough attention to this, which eventually leads to rapid deterioration of the disease and life-threatening. 1, why cirrhotic patients are prone to infection Cirrhotic patients are prone to complication of infection mainly consider the following factors: First, after cirrhosis, patients with impaired liver function, liver synthesis of innate immune molecules, such as complement, secretory pattern recognition receptors and other reduced, the body’s defense ability decreased, immune function defects. Secondly, portal hypertension causes damage to the intestinal mucosal barrier and increased permeability of the intestinal wall, and bacteria in the intestinal lumen enter the blood circulation through the lymph or portal vein. Meanwhile, ascites caused by portal hypertension is a good environment for bacterial growth, which provides favorable conditions for bacterial growth and reproduction. Thirdly, patients with decompensated cirrhosis have open portal-body collateral circulation and varices, and variceal rupture and bleeding can lead to intestinal flora translocation and infection. In addition, the advanced stage of cirrhosis patients with hypersplenism and hematopoietic function, resulting in a decrease in circulating immune cells, such as neutrophils, T cells, B cells and liver kuffer cell phagocytosis, will lead to a decrease in the patient’s ability to resist infection. 2, infection can cause those serious consequences The incidence of infection in patients with cirrhosis is 4-5 times higher than in the general population, and the consequences are more serious. Infection is often the main cause of slow plus acute liver failure. In addition, what are the serious consequences of infection in patients with cirrhosis? First, infection can induce an inflammatory response in the body, which can lead to a systemic inflammatory response in severe cases. In addition to aggravating the damage to the liver itself, it can also cause damage to other organs. Infection is a common precipitating factor for hepatic encephalopathy. It is believed that when infection is present in the body, astrocytes and endothelial cells of the brain release various inflammatory mediators, leading to increased intracranial pressure and cerebral edema. In addition, the catabolism of the body is enhanced during infection, and the production of ammonia by tissues increases, resulting in a vicious cycle. In patients with cirrhosis, hepatorenal syndrome occurs because of severe portal hypertension and visceral hyperdynamic circulation, causing decreased renal blood flow and inadequate perfusion of the renal cortex. The hepatorenal syndrome is induced by increased inflammatory mediators produced during infection, which stimulate NO production by endothelial cells, diastolic visceral vascularity, and decreased effective circulating blood volume. On the other hand, these inflammatory mediators produced by infection itself have a strong effect of constricting renal vasculature, making the kidney severely underperfused. 3.How to prevent the occurrence of infection Infection is a common cause of repeated hospitalization, decreased quality of life and increased medical costs in patients with cirrhosis. For patients with cirrhosis, it is important to avoid the occurrence of infection to stabilize the disease and improve the prognosis. In daily life, we should pay attention to the ventilation of the living room, develop good personal hygiene habits, try to avoid catching cold, unclean diet, and reduce dining out. In addition, esophagogastric variceal bleeding is an independent risk factor for infection, therefore, patients with cirrhosis, especially those in the decompensated stage, should undergo regular screening and monitoring of esophagogastric varices to actively prevent variceal bleeding. For inpatients, sterilization and isolation should be strengthened to reduce cross-infection, strict aseptic operation, minimize invasive operations, and shorten hospitalization time. For patients who need surgery or endoscopic treatment, they should be alert to perioperative infection. For patients admitted for acute bleeding, prophylactic antibiotics should be used according to the guidelines. 4. Treatment of infections in patients with cirrhosis Most patients with cirrhosis have heavy disease, poor organism response ability, and insidious symptoms and course of infection in the early stage. Early identification and diagnosis of infection is very important for the treatment of patients. At present, more studies believe that C-reactive protein (CRP) can be used as an indicator for early diagnosis and efficacy observation. It has been reported in the literature that when CRP >10 ng/ml in patients with cirrhosis indicates the presence of occult bacterial infection and/or persistent bacterial translocation-associated SIRS. Appropriate application of antibiotics is the key to infection treatment. The most common infection in patients with cirrhosis is spontaneous bacterial peritonitis (SBP), followed by respiratory tract infections, intestinal infections, sepsis, and urinary tract infections. Until the results of bacterial culture and drug sensitivity tests are available, empirical treatment should be targeted with antibiotics depending on the site and severity of the infection and the source of infection. Epidemiological data show that community-acquired infections are predominantly Gram-negative bacilli, and third-generation cephalosporins are preferred for treatment. In recent years, the proportion of Gram-positive cocci in nosocomial infections has increased due to the massive use of cephalosporins and fluoroquinolone antibiotics. Drug selection should consider vancomycin, amikacin and cotrimoxazole. In addition, patients should be alert to secondary fungal infections, do pathogen culture early, use drug sensitivity test as a guide, give adequate amount, adequate course, intravenous combination of drugs, pay attention to changes in patient’s flora, and prevent the occurrence of secondary infections. In addition, albumin infusion also plays an important role in the treatment of patients with cirrhotic infections. It is well known that the decrease of plasma albumin level in cirrhotic patients is one of the important factors in the formation of ascites. A randomized controlled study has now found that intravenous albumin infusion reduces the risk of renal failure and mortality in patients with cirrhotic infections. Albumin supplementation can help the body maintain effective circulating blood volume and alleviate renal underperfusion; and it can reduce ascites production as well as the use of diuretics. Combining it with antibiotics can improve the efficacy and prognosis. Infection is a catalyst for the progression of cirrhosis, and repeated infections put patients at a much higher risk of organ failure and death. Therefore, active prevention, early recognition and diagnosis of infection, and rational use of antibiotic therapy play a key role in improving the survival rate and quality of life of patients.