Alcohol-related liver disease (ALD) remains the most important cause of death due to alcohol. Infections, particularly bacterial infections, are one of the most frequent and severe complications of advanced ALD, as alcoholic cirrhosis and severe alcoholic hepatitis (sAH). The specific mechanisms responsible of this altered host defence become to be deciphered. The aim of the present work is to review the current knowledge about infectious complications in ALD and the pathophysiological mechanisms, distinguishing the role of alcohol consumption and the contribution of different forms of ALD. To date, corticosteroids are the sole proven effective treatment in sAH but its impact on the occurrence of infections remains controversial. The combination of an altered host defence and corticosteroids treatment in sAH has been suggested as cause of the emergence of opportunistic fungal and viral infections. High level of suspicion with systematic screening and prompt, adequate treatment are warranted to improve outcome of those patients. Prophylactic or preemptive strategies in this high-risk population might be a preferable option due to the high short-term mortality rate despite adequate therapies but should be assessed in well-designed trials before clinical implementation.