Natural fabrics are gradually becoming the ideal substrate for flexible smart wearable devices due to their excellent moisture absorption, softness, and skin-friendliness. However, the bonding fastness of the conductive layer and the corresponding durability during service have not yet been well satisfied. In this report, we successfully prepared a smart wearable multifunctional protective cotton fabric with microbreathing monitoring and rapid-photothermal antibacterial abilities of Cinnamomum camphora bark microstructure, by combining chitosan quaternary ammonium salt (HACC) with MXene nanosheets through electrostatic self-assembly. Impressively, MXene nanosheets and HACC established a strong interaction using the electrostatic attraction, endowing the fiber surface with ordered nanosheets. Meanwhile, the fabric decorated with MXene/HACC retains its original characteristics of outstanding breathability and softness, and its conductivity exhibits noticeable stability in terms of resistances to oxidation, washing, various solvents, and long-term bending cycles. On the basis of the principle of adsorption and release of water molecules in the MXene multilayer structures, the MXene/HACC fabric could accurately monitor the physiological health activities of users according to their breathing frequency and depth. Benefiting from the local surface plasmon resonance (LSPR) effect, the MXene/HACC shows encouraging photothermal conversion ability, photothermal stability under long time irradiation, washing resistance, and cycle stability. In addition, the fabric achieved an antibacterial efficiency of nearly 100% against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus within 5 min under an irradiation intensity of 400 mW/cm2. More importantly, after 10 washes, the antibacterial efficiency against the two bacteria could still reach 99.975% and 99.98%, respectively. This multifunctional protective MXene/HACC cotton fabric is expected to play a unique role in the new generation of smart wearable microbreathing sensing and against to bacterial attack, and shows a broad application prospect.