In patients with Hepatitis B virus (HBV)-related compensated liver cirrhosis and severe hepatitis flares, the purpose of the study was to identify risk factors for bacterial infections (BIs) and examine the connection of BIs with the development of acute-on-chronic liver failure (ACLF). The medical records of 237 individuals were examined in retrospect. Individuals who developed BIs and advanced to ACLF were compared to patients who didn’t have either outcome based on their baseline biochemical parameters. Before and after using a 1:1 propensity score match, researchers did univariate and multivariate logistic regression analysis to determine which characteristics were independently associated with ACLF. After being admitted, 48 patients moved on to an acute care Long-Term facility (20.3%). A further 52 (21.9%) patients had BIs prior to the onset of ACLF, and 136 (56.4%) patients had hepatic decompensation (HD). HD (84.6%) and ACLF (46.2%) were more common in patients with BIs than in those without BIs (49.7% and 13.0%, respectively; P<0.01). Independent risk variables for BIs included the CTP score (OR 1.660, 95% CI 1.267-2.175) and the MELD-Na score (OR 1.082, 95% CI 1.010-1.160). Independent risk variables for ACLF development were the presence of BIs (OR 4.037, 95% CI 1.808-9.061), the CLIF-SOFA score (OR 2.007, 95% CI 1.497-2.691), and the MELD-Na score (OR 1.167, 95% CI 1.073-1.260). After adjusting for confounding variables, BIs were found to be an independent risk factor for admission to an ACLF (OR 4.730, 95% CI 1.520-14.718). In patients with HBV-related compensated liver cirrhosis and severe hepatitis flares, BIs are risk factors for progressing to ACLF, while high CTP and MELD-Na scores are risk factors for BIs.