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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain major surgical or invasive procedure: exploratory laparotomy, drainage of subdiaphragmatic bilateral abscess, drainage of pelvic abscess, drainage of pericolic gutter abscess both on the right and left side. drainage interloop abscess. 1. exploratory laparotomy. 2. washout, drainage interloop abscess and component separation. 3. ventral hernia repair with mesh. (open abdomen) exploratory laparotomy, abdominal washout. exploratory laparotomy, hartmann's procedure, and rigid sigmoidoscopy for distal sigmoid perforation picc line placement picc left side placed paracentesis post pyloric feeding tube 2 pigtail drains placed abdominal wound vac placed history of present illness: 49 year old female with recently diagnosed alcoholic cirrhosis and transferred from for abdominal pain. patient has been complaining of intermittent abdominal pain for the past 4 weeks. this has been getting progressively worse for the past 3-4 days, diffuse and sharp in nature. associated with fevers, chill, decreased urine output and diarrhea x 4 days. she was diagnosed with esld about 3 months ago without h/o sbp. she states she was drinking 6 glasses of wine a day, but has not been drinking for the past weeks. she went to osh yesterday, she was noted to have leukocytosis with wbc 30.8, was given vancomycin/zosyn and transferred to the micu at . in the micu patient had diagnostic tap which showed 6000 wbc, 85 polys and the culture is growing gnrs. she was treated empirically for sbp and transferred to the floor as she was hemodinamically stable. given worsening abdominal pain and tenderness a ct was done showing diffuse loculated free air concerning for pneumatosis and visceral perforation. ros: (+) per hpi (-) denies unexplained weight loss, bleeding, syncope, paresthesias, nausea, vomiting, hematemesis, melena, brbpr, dysphagia, chest pain, shortness of breath, cough, edema, urinary frequency, urgency past medical history: past medical history: asthma, alcoholic cirrhosis past surgical history: appendectomy at age 19 social history: - tobacco: pack per day, extensive history - alcohol: 6 drinks per day, last drink 1 week ago - illicits: denies family history: non-contributory physical exam: physical exam: vitals: vs t 98.7 hr 97 115/54 rr 20 97%ra gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: distended, tense with diffuse tenderness to palpation. positive guarding and slight rebound on left flank. ext: no le edema, le warm and well perfused laboratory: lactate:2.0 136 101 80 -------------< 103 2.7 17 1.9 ca: 8.3 mg: 1.8 p: 4.2 alt: 11 ap: 92 tbili: 1.8 alb: ast: 37 19.8 > 30.0 < 126 pt: 18.3 ptt: 54.0 inr: 1.7 imaging: ruq u/s: 1. coarse echotexture and lobulated contour of the liver, suggestive of cirrhosis. no discrete hepatic lesion is identified. 2. cbd is dilated measuring up to 11 mm in maximum diameter. no biliary stone is visualized. 3. moderate-to-large amount of ascites within the abdomen with increased echogenicity and internal septations. ct a/p (prelim): 1. diffuse intra-abdominal ascites and free air with areas of loculated air (also possibly pneumatosis)consistent with perforated viscous. small bowel appears thickened (image 2:63) which in the setting of ascites may be a result of portal hypertension, however the constellation of findings indicates visceral perforation possibly on the basis of ischemia. the exact area of perforation is unable to be determined. 2. bilateral pleural effusions 3. no evidence of hydronephrosis or nephrolithiasis. 2:45 pm abscess left povacolic area. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (preliminary): yeast, presumptively not c. albicans. isolated from broth media only, indicating very low numbers of organisms. identification performed per dr . pertinent results: 10:45pm blood wbc-25.6* rbc-3.49* hgb-11.5* hct-34.3* mcv-98 mch-32.9* mchc-33.4 rdw-13.0 plt ct-192 08:15am blood wbc-13.3*# rbc-3.58*# hgb-11.1*# hct-33.1*# mcv-93 mch-30.9 mchc-33.4 rdw-16.9* plt ct-225# 05:50am blood pt-20.7* ptt-28.0 inr(pt)-2.0* 05:50am blood glucose-113* urean-15 creat-0.4 na-140 k-3.4 cl-110* hco3-25 angap-8 05:50am blood alt-14 ast-28 alkphos-116* totbili-1.2 05:50am blood albumin-2.1* calcium-7.6* phos-2.4* mg-1.9 03:15pm blood hbsag-negative hbsab-negative hbcab-negative 09:30am blood vanco-17.9 11:00 pm peritoneal fluid **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). reported to and read back by cc6c @ 0204 on . fluid culture (final ): escherichia coli. moderate growth. piperacillin/tazobactam sensitivity testing performed by . cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. klebsiella pneumoniae. sparse growth. piperacillin/tazobactam sensitivity testing performed by . cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | klebsiella pneumoniae | | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s 4 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s anaerobic culture (final ): bacteroides fragilis group. moderate growth. time taken not noted log-in date/time: 2:42 pm urine site: not specified **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml.. 1:33 pm abscess source: paracolic gutter abscess. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (preliminary): albicans, presumptive identification. rare growth. fluconazole sensitivity performed per dr . bacillus species; not anthracis. isolated from broth media only, indicating very low numbers of organisms. anaerobic culture (final ): no anaerobes isolated. brief hospital course: 49 f with h/o etoh abuse and newly diagnosed cirrhosis, presented from outside hospital with abdominal pain, found to have sbp. she was admitted to the micu and started on ceftaz. creatinine was acutely elevated and she was acidotic. lactate was 2.3 in the ed. this was most likely secondary to hypoperfusion in the setting of infection. patient received 2l of crystalloid in the ed. liver us demonstrated dilated cbd measuring up to 11 mm in maximum diameter without stone. there was moderate-to-large amount of ascites with septations. surgery was consulted for rising lactate, worsening abdominal pain and tenderness. ct showed diffuse loculated free air concerning for pneumatosis and visceral perforation. on , she was taken to the or by dr. for free air and suspected perforation. exploratory laparotomy, drainage of subdiaphragmatic bilateral abscess, drainage of pelvic abscess, drainage of pericolic gutter abscess both on the right and left side. drainage interloop abscess. postop, she was managed in the sicu. she was taken back to the or on for exploratory laparotomy, washout, drainage interloop abscess and component separation and ventral hernia repair with mesh. postop, she went back to the sicu, weaned off pressors and was extubated. a post pyloric dobhoff was placed and restaints placed as pt attempted to remove dobhoff. picc line was placed on . psych was consulted for agitation/confusion. zyprexa was recommended. on she went back to or for ex-lap, abd was left open, as source of leak was not identified. 2rbc, 2ffp, and 1400 ns were required. she became hypotensive and tachycardic. albumin, ns bolus and levophed were given. hct improved to 32. abdomen was closed on (fascia closed with interposition mesh, skin closed with staples)end colostomy when a recotosigmoid leak was identified. she was extubated, continued on tpn, started on vancomycin again. she was transferred to the floor on . on a wound vac was placed to promote granulation and healing since her wound began to dehisce. on ortho was consulted for recent h/o shoulder fracture. xrays were done (right humeral fx)and non-operative management was recommended. by the wound was completely open and vac remained in place. she was briefly started on tpn and then on tfs which she is leaving on. she was sent to ir to tap fluid collection in abdomen which were d'c'ed on (r) and (l). she was spiking fevers w/ leukocytosis until . her wbc count remains high, but is currently afebrile and on azithromycin for mycoplasma grown from a wound culture and fluconazole for from a wound culture. she is also on zosyn for empiric gram negative coverage. #etoh abuse: patient with history of etoh abuse. has not had significant withdrawal episodes in the past. last drink was 5 days ago. patient most likely outside of the window for dt. -ciwa precaution -thiamine, folate, multivitamin -social work consult medications on admission: albuterol prn, ibuprofen prn discharge medications: 1. outpatient lab work twice weekly (monday and friday) cbc, chem 10, ast, alt, alk phos, t.bili, albumin, pt/inr, ptt 2. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 3. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezes. 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 7. insulin regular human 100 unit/ml solution sig: see sliding scale injection asdir (as directed). 8. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain: do not give more than 2000mg per day. 9. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours). 10. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours). 11. micafungin 100 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 12. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 13. famotidine(pf) in (iso-os) 20 mg/50 ml piggyback sig: one (1) intravenous q12h (every 12 hours). 14. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 15. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) dose intravenous q8h (every 8 hours). 16. dextrose 50% in water (d50w) syringe sig: one (1) intravenous prn (as needed) as needed for hypoglycemia protocol. 17. azithromycin 500 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 18. fluconazole in nacl (iso-osm) 200 mg/100 ml piggyback sig: one (1) intravenous q24h (every 24 hours). 19. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. discharge disposition: extended care facility: - discharge diagnosis: rectosigmoid perforation procedure peritonitis, abdominal abscess uti, yeast abdominal wound malnutrition anemia bilateral pleural effusions 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: call dr. office if any of the warning signs listed below patient will followup with id in 2 weeks and she needs a ct scan of her abdomen with po contrast prior to this appt. followup instructions: provider: , md phone: date/time: 9:00 provider: , md phone: date/time: 1:30 provider: , md phone: date/time: 11:00 procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage colostomy, not otherwise specified reopening of recent laparotomy site reopening of recent laparotomy site other open incisional hernia repair with graft or prosthesis open and other sigmoidectomy other laparotomy rigid proctosigmoidoscopy central venous catheter placement with guidance diagnoses: acidosis tobacco use disorder acute kidney failure with lesion of tubular necrosis friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site alcoholic cirrhosis of liver hepatorenal syndrome unspecified protein-calorie malnutrition candidiasis of other urogenital sites perforation of intestine asthma, unspecified type, unspecified incisional hernia without mention of obstruction or gangrene other sequelae of chronic liver disease other ascites hepatic encephalopathy hypovolemia peritoneal abscess other candidiasis of other specified sites delirium due to conditions classified elsewhere diverticulosis of colon (without mention of hemorrhage) other and unspecified alcohol dependence, continuous disruption of external operation (surgical) wound spontaneous bacterial peritonitis other and unspecified escherichia coli [e. coli] physical restraints status aftercare for healing traumatic fracture of upper arm 

Answer: The patient is high likely exposed to