Infection, antibiotic therapy and risk of colorectal cancer: a nationwide nested case-control study in patients with Type 2 diabetes mellitus

Int J Cancer. 2014 Aug 15;135(4):956-67. doi: 10.1002/ijc.28738. Epub 2014 Mar 21.


Patients with Type 2 diabetes mellitus are at a higher risk of colorectal cancer (CRC). The objective of our study was to examine the inter-relationship among infection sites, systemic antibiotic use and risk of CRC among patients with Type 2 diabetes mellitus. From a diabetic cohort from the Taiwan's National Health Insurance claims database, we identified 3,593 incident colon cancer cases, 1,979 rectal cancer cases and 22,288 controls and conducted a nested case-control study to examine the association between antibiotic use and CRC incidence. Logistic regression models were applied to estimate the odds ratio (OR) and the 95% confidence interval (95% CI) between infection sites, antibiotic use and CRC incidence. Patients with intra-abdominal infection were significantly associated with increased risk for colon cancer (OR = 2.01, 95% CI = 1.73-2.35) and rectal cancer (OR = 1.59, 95% CI = 1.26-2.00). Any antianaerobic antibiotic use was associated with a higher risk of colon cancer (OR = 2.31, 95% CI = 2.12-2.52) and rectal cancer (OR = 1.69, 95% CI = 1.50-1.90) but without an obvious dose-response relationship for cumulative use. Antianaerobic antibiotics also increased the risks for those with nonintra-abdominal infection. No association was found between antiaerobic agent use and the CRC risk. The results suggest intra-abdominal infections and antianaerobic antibiotic use may be a marker for precancerous lesions or early CRC, although the possibility of antianaerobic antibiotics playing an additional role cannot be excluded. Further research examining the relationship between intra-abdominal infection, antianaerobic antibiotics use and possible change of microbiota leading to colorectal carcinogenesis is warranted.

Keywords: antibiotics; colon neoplasms; diabetes mellitus; intra-abdominal infection; rectal neoplasms.

MeSH terms

  • Aged
  • Algorithms
  • Anti-Bacterial Agents / adverse effects*
  • Bacterial Infections / complications*
  • Bacterial Infections / drug therapy
  • Case-Control Studies
  • Cohort Studies
  • Colorectal Neoplasms / complications*
  • Colorectal Neoplasms / epidemiology*
  • Comorbidity
  • Diabetes Complications / epidemiology*
  • Diabetes Mellitus, Type 2 / complications*
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Regression Analysis
  • Reproducibility of Results
  • Risk Factors
  • Taiwan


  • Anti-Bacterial Agents