Objective:

To determine whether intensive-dose atorvastatin (≥40 mg/d) increases the risk, severity, or incidence of multidrug-resistant bacterial infections in post-stroke pneumonia compared to standard-dose therapy (20 mg/d).

Approach:

• Study Design: Retrospective analysis of 3,199 AIS patients using propensity score matching to balance baseline characteristics.
• Outcome Measures: Incidence of post-stroke pneumonia (PSP), pneumonia severity (CURB-65 scores), and rates of multidrug-resistant (MDR) bacterial infections were compared.
• Statistical Analysis: Multivariate logistic regression was applied to identify independent risk factors for PSP.

Key Findings:

• No significant difference in PSP incidence between intensive (8.8%) and standard atorvastatin groups (8.3%, p = 0.691).
• Intensive treatment was not associated with increased PSP risk before (OR = 1.074, 95% CI: 0.756–1.525) or after matching (OR = 1.002, 95% CI: 0.672–1.492).
• No significant differences in severe pneumonia (21.4% vs. 20.2%, p = 0.863) or MDR infection incidence (9.5% vs. 10.1%, p = 0.897) between groups.

Interpretation:

High-intensity atorvastatin therapy during acute ischemic stroke did not increase the risk or severity of pneumonia, nor did it elevate MDR bacterial infections.

Limitations:

• Retrospective design may introduce biases.
• Findings are based on a single-center study, limiting generalizability.

Conclusion:

Intensive atorvastatin therapy is not associated with an increased risk of post-stroke pneumonia.