Clostridium Difficile
Clostridioides difficile infection (CDI) is one of the most common health-care associated infections and a major cause of morbidity and mortality. While acute CDI can be successfully treated in most cases with specific antibiotics, about 25% of people relapse after treatment, and many of these go on to develop multiple relapses, which are extremely challenging to manage. The two best current approaches to managing relapses are taper-pulse antibiotic courses and fecal microbial therapy (FMT), but there are many unanswered questions about the appropriate use of these treatment modalities, as well as new products in various clinical trial stages. There are also important scientific questions about how CDI develops, and the role of the immune system in preventing recurrences.
Research program
The Steiner lab has studied the immune response to CDI, with a focus on T cell responses to the toxins that are responsible for causing disease (TcdB and TcdA). In a recently completed study, they followed over 80 patients prospectively during and after their first episode of CDI, to determine immune and microbiologic predictors of relapse. Ongoing work is examining the role of innate immunity in infection, using animal models.
Dr. Steiner is also involved in several ongoing clinical research projects on CDI.
Current Projects
- RESTORATIVE (sponsor: Vedanta): Phase III RCT of oral synthetic microbiome to prevent CDI recurrence
- PRISM (sponsor: Astra Zeneca): Phase II RCT of new monoclonal antibody to TcdB to prevent CDI recurrence
- SPORES-V (sponsor: McGIll/CIHR funded): adaptive platform trial to examine vancomycin prophylaxis and taper/pulse treatments for CDI
- Retrospective, single-centre analysis of FMT success and complications
Team
Ted Steiner
Ria Perenszik
Gale Ladua
Chad Poloni
Xiaojiao Wang
Nada Al-Emadi
Seohee An
VCHRI Clinical Research Unit
Featured Publications
- Theodore Steiner, Thomas Louie, Dina Kao, Dan Smyth, Beth Guthmueller, Tracey Jason, Susan N. Elliott, Shivam Srivastava, Christine Lee. Evaluation of Fecal Microbiota, Live (RBL), for the Prevention of Recurrent Clostridioides difficile Infection: Canadian Subgroup Analysis of an Open-Label Phase 3 Study. Accepted for publication, J. Canadian Gastroenterol. Assoc.
- McDonald EG, Butler-Laporte G, Brophy JM, Elsayed S, Frenette C, Huseen I, Loo VG, Moran K, Coburn B, Hota SS, Longtin Y, Kong LY, Muller MP, Steiner TS, Valiquette L, Daneman N, Daley P, Nott C, MacFadden DR, Kandel CE, Chen Y, Perez-Patrigeon S, Lee TC; TAPER-V Team. Initial Vancomycin Taper for the Prevention of Recurrent Clostridioides difficile Infection: A Randomized Clinical Trial. JAMA Netw Open. 2026 Feb 2;9(2):e2560495.
- Feuerstadt P, Chopra T, Knapple W, Van Hise NW, Dubberke ER, Baggott B, Guthmueller B, Bancke L, Gamborg M, Steiner TS, Van Handel D, Khanna S. PUNCH CD3-OLS: a phase 3 prospective observational cohort study to evaluate the safety and efficacy of fecal microbiota, live-jslm (REBYOTA) in adults with recurrent Clostridioides difficile infection. Clinical Infectious Diseases. 2025;80(1):43-51.
- Kao D, Wong K, Lee C, Steiner T, Franz R, McDougall C, Silva M, Schmidt TSB, Walter J, Loebenberg R, Monaghan TM, Giebelhaus RT, Harynuk JJ, Xu H, Yaskina M, MacDonald KV, Marshall DA, Louie T. Effects of lyophilised faecal filtrate compared with lyophilised donor stool on Clostridioides difficile recurrence: a multicentre, randomised, double-blinded, non-inferiority trial. Lancet Gastroenterol Hepatol. 2025 Nov;10(11):986-997. doi: 10.1016/S2468-1253(25)00190-6. Epub 2025 Sep 22. PMID: 40997843.
- Kraft CS, Sims M, Silverman M, Louie TJ, Feuerstadt P, Huang ES, Khanna S, Berenson CS, Wang EEL, Cohen SH, Korman L, Lee C, Kelly CR, Odio A, Cook PP, Lashner B, Ramesh M, Kumar P, De A, Memisoglu A, Lombardi DA, Hasson BR, McGovern BH, von Moltke L, Pardi DS; ECOSPOR III and ECOSPOR IV investigators. (2024). Integrated Safety and Efficacy Analyses of Phase 3 Trials of a Microbiome Therapeutic for Recurrent CDI. Infect Dis Ther. https://doi.org/10.1007/s40121-024-01007-z
- Laura Cook, May Q Wong, William D Rees, Alana Schick, Daniel J Lisko, Genelle R Lunken, Xiaojiao Wang, Hannah Peters, Laura Oliveira, Torey Lau, Regan Mah, Brian Bressler, Megan K Levings*, Theodore S Steiner* (2023). Dysregulated Immunity to Clostridioides difficile in IBD Patients Without a History of Recognized Infection. Inflammatory bowel diseases, izad238.
- Mah, R., Locher, K., Steiner, T. S.,* & Stefanovic, A.* (2023). Clostridioides difficile PCR Tcdb Cycle Threshold predicts toxin EIA positivity but not severity of infection. Anaerobe, 82, 102755.
- Laura Cook, May Q Wong, William D Rees, Alana Schick, Daniel J Lisko, Genelle R Lunken, Xiaojiao Wang, Hannah Peters, Laura Oliveira, Torey Lau, Regan Mah, Brian Bressler, Megan K Levings*, Theodore S Steiner* (2023). Dysregulated Immunity to Clostridioides difficile in IBD Patients Without a History of Recognized Infection. Inflammatory bowel diseases, izad238.