Case study -

What an awful holiday season it had been for Danielle, an 11th grader at Ithaca High School. It all started right before Thanksgiving when she had to have her wisdom teeth removed. Her mouth hurt so much she couldn't enjoy most of the Thanksgiving meal. That and the antibiotic she was taking, clindamycin, gave her a metallic taste in her mouth, and so even the mashed potatoes she could eat didn't taste right. On Thanksgiving, her 83-year-old grandmother had fallen and broken her thumb and elbow. She had been in the hospital for a few days and then in a rehab center for a week. When Danielle had visited her grandmother in the rehab center, she had seemed to be in good spirits and was looking forward to getting ready for the Christmas holiday.

Shortly before Christmas, Danielle's grandmother developed watery diarrhea. Her doctor told her to take Imodium® A-D, an anti-diarrhea medicine that works by slowing down intestinal motility. The next day she had terrible abdominal cramping and Danielle's father took her grandmother to the urgent care center. As soon as they tookher vital signs and heard her history, they sent her to the emergency room. From there Danielle's grandmother was admitted to the intensive care unit with a diagnosis of kidney failure due to dehydration induced by diarrhea caused by infection with Clostridium difficile.

1. What are the risk factors for developing Clostridium difficile disease?

2. Which of these risk factors did Danielle's grandmother probably have?