Intensive Versus Standard Statin Therapy in Acute Ischemic Stroke: A Comparative Study on the Risk of Pneumonia and Multidrug-Resistant Bacterial Infections

Background The use of intensive statin therapy in acute ischemic stroke (AIS) is common; however, its association with post-stroke pneumonia (PSP) remains uncertain. This study aimed to determine whether intensive-dose atorvastatin (≥ 40 mg/d) increases the risk, severity, or incidence of multidrug-resistant (MDR) bacterial infections in PSP compared to standard-dose therapy (20 mg/d). Methods We retrospectively analyzed 4,843 AIS patients admitted to the First Affiliated Hospital of Wenzhou Medical University between January 2020 and January 2022. After applying inclusion and exclusion criteria, 3,199 patients were included. Propensity score matching (PSM) was used to balance baseline characteristics between the intensive and standard atorvastatin groups. The incidence of PSP, pneumonia severity (evaluated by CURB-65 scores), and MDR bacterial infection rates were compared. Multivariate logistic regression was applied to identify independent risk factors for PSP. Results After PSM, no significant difference was observed in PSP incidence between the intensive and standard atorvastatin groups (8.8% vs. 8.3%, p = 0.691). Multivariate regression confirmed that intensive treatment was not associated with increased PSP risk, either before (OR = 1.074, 95% CI: 0.756–1.525) or after matching (OR = 1.002, 95% CI: 0.672–1.492). Among the 173 PSP patients, there were no significant differences in the proportion of severe pneumonia (21.4% vs. 20.2%, p = 0.863) or MDR bacterial infection incidence (9.5% vs. 10.1%, p = 0.897) between the two groups. Conclusions Intensive atorvastatin treatment during the acute phase of ischemic stroke did not increase the risk or severity of pneumonia, nor did it elevate MDR bacterial infections. These findings support the safe use of statins in AIS patients and offer insights for optimizing clinical treatment strategies. Clinical trial number: Not applicable.