​A popular sugar additive could have fueled epidemic strains of Clostridium difficile, according to a January 3, 2018, study in Nature. The authors observed that two virulent strains of C. difficile—ribotype 027 and ribotype 078—are very good at metabolizing low concentrations of the sugar trehalose. Trehalose is used as a flavor or texture enhancer in a variety of food products, including pasta, ice cream, cake, and chewing gum. It was infrequently used until the turn of the twenty-first century because of high production costs, according to an accompanying article in Nature. This coincides with the rise of the C. difficile epidemic, the article said. It is possible, the author said, that adding trehalose to the food supply increased sugar enough in human bowels to enable the growth of C. difficile. If a hospital or long-term care facility has a C. difficile outbreak featuring ribotype 027 or ribotype 078, then it should modify patient and resident diets to restrict trehalose consumption, one of the study's authors said in a January 4, 2018, article in Medical News Today. “It is impossible to know all the details of events surrounding the recent C. difficile epidemics," the author said, “but the circumstantial and experimental evidence points to trehalose as an unexpected culprit." 

HRC Recommends: Healthcare organizations regularly seek methods to reduce the incidence of C. difficile infections. Risk managers should discuss this study with an infectious disease physician. Organizations might start tracking which foods provided to patients contain trehalose and look at the number of patients who develop C. difficile during an inpatient hospital stay. Furnished with this information, a performance-improvement committee could conduct a review to determine whether there are strategies to lower the risk of acquiring C. difficile infection.