Decompensated liver disease is a huge burden on countries that suffer from high rates of chronic hepatitis or alcoholism, also recently NASH entered in the strong contenders after the regression of chronic HCV with oral direct antivirals. Liver decompensation in the form of hepatocellular or vascular decompensation carries the risk of disturbed immune response and liability to infections as SBP, pneumonia, chest infections, cellulitis, UTI, etc, that differ in their prognosis from the healthy liver patients. In addition, the spectrum of organisms differs with the subsequent difference in the responding regimens for treatment and liability for resistance is higher due to high recurrence rates. Thus the guidelines for dealing with such infections are specific, especially as the liver decompensation carries another limitation of the choice of drugs with a higher risk of complications. We will also discuss recent resistance antibiotic patterns that has developed and how to deal with them, the importance of cultures in these cases. Added to this; the importance of prevention and the regimens used for different infections. And the risk of acquiring infections from hospitalization itself, whether ward or ICU (including the different spectrum of the organisms that affect patients present in these environments). Pathophysiology for the disturbed immune response will be discussed.