Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: aspirin / sulfa (sulfonamide antibiotics) attending: chief complaint: llq abdominal pain, diarrhea major surgical or invasive procedure: : percutaneous g-j tube replacement history of present illness: patient is a 70m who is well-known to the west 2 surgical service. he has a complex medical history of gallstone pancreatitits, with necrotizing pancreatitis and abdominal compartment syndrome requiring decompressive laparotomy. at the subsequent reattempt at abdominal closure, the patient again developed abdominal compartment syndrome. his course was significant for respiratory and renal failure ultimately requiring tracheostomy/peg tube placement. he also had infectious complications from his hospital course. he recovered well from this initial insult. the patient required three laparoscopic necrosectomies. however, the patient developed a pancreatico--cutaneous fistula that has healed well in the interim. he was recently admitted to and dishcarged in . since then, he has been at rehab where he has been tolerating passy-muir valve and walking with assistance. two days ago, he began to develop left lower quadrant abdominal pain with 2 episodes of diarrhea 2 days ago and 5 episodes yesterday. he was told that he had a diagnosis of c difficile colitis at the rehabilitation facility, which was later confirmed. he is now transferred to for further care given increasing llq tenderness and pain. past medical history: pmhx: asthma, htn, basal cell carcinoma, dm, gallstone pancreatitis c/b respiratory and renal failure, abdominal compartment syndrome, necrotizing pancreatitis pshx: rib frx plating approx 5 years ago. on last admission closure, gj tube partial abd closure, drsg open abdomen dressing revision decompressive laparotomy, open abd partial closure abdominal wound formal closure gj tube decompressive laparotomy, open abd tracheostomy abdominal closure with mesh and -i&d of pancreatic fluid collection and subsequent upsizing of drain by ir , , -laparoscopic pancreatic necrosectomy social history: married for 45+ years. three daughters, one son. retired six years ago, owned upholstery business. never smoker, one glass of wine per evening with dinner. no illicits. family history: sister died from breast cancer, another sister (deceased) with crf on hd physical exam: on admission: vs: 96.9 107 105/70 20 99%ra general: awake and alert cv: rrr lungs: cta bilaterally abdomen: soft, (+) llq tenderness, + rebound on palpation of llq, no other rebound/guarding, hypoactive bs rectal: heme (-), loose yellow stool noted ext: warm, no edema . at discharge: vs: 97.7 po, 110, 118/78, 20, 98% ra gen: deconditioned in nad. heent: sclerae anicteric. o-p clear. neck: supple. prior tracheostomy site (now decannulated) clean/intact with dsd cover. lungs: cta(b) cor: episodic tachycardia, otherwise rrr. abd: graft clean, healing well. g-j tube patent/intact. site benign. bsx4. soft/nt/nd. extrem: wwp; no c/c/e neuro: a+ox3. pleasant. deconditioned. pertinent results: on admission: 09:24pm urine blood-sm nitrite-pos protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 09:15pm glucose-115* urea n-23* creat-1.3* sodium-137 potassium-3.3 chloride-103 total co2-25 anion gap-12 09:15pm calcium-8.5 phosphate-2.9# magnesium-1.7 02:11pm lactate-2.1* 02:00pm glucose-149* urea n-25* creat-1.5* sodium-136 potassium-3.9 chloride-98 total co2-28 anion gap-14 02:00pm alt(sgpt)-7 ast(sgot)-19 alk phos-75 tot bili-0.5 02:00pm lipase-30 02:00pm wbc-11.9* rbc-3.38* hgb-9.9* hct-30.3* mcv-90 mch-29.3 mchc-32.7 rdw-15.5 02:00pm neuts-83.1* lymphs-11.7* monos-4.4 eos-0.7 basos-0.1 02:00pm plt count-283 02:00pm pt-15.9* ptt-24.4 inr(pt)-1.4* . imaging: abd/pelvic ct w/contrast: 1. wall thickening of the rectum, sigmoid, descending and transverse colon with surrounding fat stranding compatible with colitis. the etiology are most likely infectious or inflammatory in nature. c. diff. colitis may explain these findings. ischemic etiology is felt less likely, although not entirely excluded. 2. slightly smaller fluid and air collection in the mid pancreas, extending inferiorly, compared to prior study from . clinical correlation for possible acute process is recommended. 3. right lower lobe consolidation with heterogeneous enhancement and calcification and soft tissue in a lower lobe bronchus may represent post-obstructive pneumonia. while this can be secondary to mucous secretions, given that it persists since prior exams, underlying endobronchial lesion can not be excluded. suggest pulmonary consultation for possible bronchoscopy. 4. multiple liver hypodensities are grossly stable. 5. severe coronary artery calcifications. . ap cxr: single ap upright portable view of the chest was obtained. right basilar opacity persists which may represent consolidation, partial right lower lobe collapse and/or effusion. chest ct is pending. minimal blunting of the left costophrenic angle may be due to a trace effusion versus pleural thickening, without significant interval change. tracheostomy tube is again seen. there is no significant interval change in the mediastinal or cardiac silhouettes. no overt pulmonary edema is seen. . cxr: stable chest findings, no new pulmonary abnormalities since the next preceding study. . microbiology: stool fecal culture-final; campylobacter culture-final; ova + parasites-final; clostridium difficile toxin a & b test-final: fecal culture (final ): no appropriate specimen received for the requested test, specimen on transport media received. test not performed. patient credited. campylobacter culture (final ): test not performed no appropriate specimen received for the requested test, specimen on transport media received. patient credited. ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. . few polymorphonuclear leukocytes. charcot- crystals present. clostridium difficile toxin a & b test (final ): test not performed no appropriate specimen for the requested test, specimen on transport media received. patient credited. . blood culture: no growth to date - prelim. blood culture: no growth to date - prelim. urine urine culture-preliminary {escherichia coli}: escherichia coli. 10,000-100,000 organisms/ml stool clostridium difficile toxin a & b test-final {clostridium difficile): positive. stool fecal culture-final; campylobacter culture-final; clostridium difficile toxin a & b test-final: **final report ** fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . mrsa screen: negative. mrsa screen: negative. urine urine culture-final {escherichia coli}: **final report ** urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 32 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . blood culture: no growth to date. brief hospital course: the patient was admitted to the general surgical service for evaluation and treatment of abdominal apin and diarrhea. admission abdominal/pelvic ct revealed wall thickening of the rectum, sigmoid, descending and transverse colon with surrounding fat stranding compatible with colitis. the etiology are most likely infectious or inflammatory in nature. c. diff. colitis consistent with these findings. blood, urine , and stool cultures were sent. the patient was made npo, started on iv fluid rescusitation, a foley catheter was placed, and the patient started on iv flagyl and oral and rectal vancomycin. the patient was hemodynamically stable. . neuro: the patient did not experience any significant pain, and did not require pain medications other than acetaminophen prn. he remained neurologically intact. he required physical therapy due to his deconditioned status. discharge to rehabiliation facility was recommended. . cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. he was continued on metoprolol iv q6hours while admitted. . pulmonary: the patient underwent tracheostomy during a prior, prolonged admission for respiratory failure. the patient had been tolerating passy-muir valve. his tracheostomy was capped for 2 days during this admission with no complications or phonation difficulties. on , the patient was decannulated without problem, and a dsd dressing applied. the patient remained stable from a pulmonary standpoint. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. . gi/gu/fen: upon admission, the patient was made npo with iv fluids. after the gj-tube was replaced as the formed one was cracked on , tubefeeds via the j-port of the gj-tube were restarted, and advanced back to goal with good tolerability. foley catheter was discontinued on ; the patient subsequently voided without problem. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. . id/integ: upon admission, the patient was pan-cultured, including stool cultures and c. diff, and the patient started on iv flagyl, and po and rectal vancomycin. after admission, confirmation from rehab hospital of a positive c. diff screen was received. ciprofloxacin was added on for e. coli uti. the infectious disease service was consulted; their recommendations appreciated and followed. cipro was discontinued on as the urine c&s revealed cipro to be resistant. repeat urine culture confirmed multi-antibiotic resistant e. coli. iv unasyn was started. rectal vancomycin was also discontinued. the patient was discharged on flagyl and po vancomycin to complete a two week course. wound care: the abdomninal skin graft remained clean, intact, and was healing nicely. xerofoam was placed on the graft with a dsd cover. the gj-tube site remained benign. . endocrine: the patient's blood sugar was monitored throughout his stay; sliding scale insulin was administered when indicated. . hematology: the patient's complete blood count was examined routinely; no transfusions were required. . prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. . at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating continuous tubefeeds via the j-port of the gj-tube at goal, ambulating with assistance, voiding without assistance, and was not experiencing any significant pain. he was discharged back to a rehabilitation facility, where he will complete a two week course of antibiotic therapy for clostridium difficile colitis. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. ondansetron hcl (pf) 4 mg/2 ml solution sig: two (2) ml injection q8h (every 8 hours) as needed for nausea. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain / fever. 4. olanzapine 5 mg tablet, rapid dissolve sig: two (2) tablet, rapid dissolve po daily (daily). 5. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 8. acetylcysteine 20 % (200 mg/ml) solution sig: 3-5 mls miscellaneous q6h (every 6 hours) as needed for secretion. 9. nutrition please continue enteral feeds: replete with fiber full strength 40 ml/hr with 30 ml water flush q6h. medium chain triglycerides 25 ml qid. 10. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed for wheezing. discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 2. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 3. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 4. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 6. lorazepam 0.5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for anxiety. 7. zantac 150 mg tablet sig: one (1) tablet po twice a day. 8. zofran odt 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 9. dulcolax 10 mg suppository sig: one (1) rectal once a day as needed for constipation. 10. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po every six (6) hours as needed for gi gassiness, bloating. 11. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 12. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 13. quetiapine 25 mg tablet sig: 0.5 tablet po once a day. 14. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one hundred (100) ml (500mg) intravenous every eight (8) hours: completion date: . 15. metoprolol tartrate 5 mg/5 ml solution sig: 0.5 ml (2.5mg) intravenous every six (6) hours: hold for hr<60 or sbp<100 . 16. vancomycin 250 mg capsule sig: one (1) capsule po every six (6) hours: completion date: . 17. ampicillin-sulbactam 3 gram recon soln sig: one (1) recon soln injection every six (6) hours for 5 days. 18. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous qid (4 times a day) for 11 days: completion date . discharge disposition: extended care facility: - discharge diagnosis: 1. clostridium difficile colitis 2. resistant escherichia coli uti discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: please call your doctor or return to the hospital if you experience: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. . general discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. . gj-tube care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *wash the area gently with warm, soapy water or 1/2 strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. change daily and as needed. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. * flush g and j-ports of gj-tube with 30ml water q4hours. followup instructions: provider: , md phone: date/time: 1:15. location: 3, . procedure: enteral infusion of concentrated nutritional substances removal of tracheostomy tube replacement of tube or enterostomy device of small intestine diagnoses: urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified personal history of other malignant neoplasm of skin intestinal infection due to clostridium difficile chronic pancreatitis mechanical complication of colostomy and enterostomy attention to tracheostomy 

Answer: The patient is high likely exposed to