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: tachypnea and tachycardia noted at facility major surgical or invasive procedure: percutaneous cholecystostomy tube placement right internal jugular vein central venous catheter placement history of present illness: 52 yo m with h/os anoxic brain injury substance abuse s/p trach and peg (which occurred in rehab), recent admission for g-tube related complication discharged on transferred from rehab for tachypnea and tachycardia. . of note, patient was recently admitted from for malpositioned g tube (after a manual g-tube replacement in the rehab)in the left rectus muscle complicated by sepsis, s/p debridement and later replacement. he was found to have urinary tract infection during that admission with klebsiella and psuedomonas and was discharged on bactrim for uti. . patient was noted to have 1 day of tachypnea and tachycardia. his rr was up to 40s with abdominal breathing. he was started on ceftin 500 mb x 7 days on for uti in additional to the bactrim that he was discharged on. flagyl 500 mg tid was also started for planned x 10 days for ? c. diff given increased stool frequency. outside lab noted for wbc 15.6, hgb 14, hct 40, plt 323, diff of 82.6% neutrophils, na 132, k 4.3, cl 95, hco3 21, bun 25, crt 1. upon transfer, vs were bp 112/70, hr 116, rr 40, t 98.6, pox 95 ra. . en route, hr was 115, sbp 97/50 (received 300 cc ns bolus x 1), pox mid-90s on 35 % tm, af. fsbs 135 . in the ed, initial vs were: 99.0 118 118/76 32 94% 50% o2 mask via trach. patient was noted to be unresponsive (baseline) with aniscoria left 4 mm and right 6 mm, + crackles. rectal temperature was noted to be 104. he got 1000 mg iv tylenol. he also received ivf and metoprolol 5 mg iv x 1 for sinus tachycardia. ekg showed sinus tachycardia at 117, normal axis, normal interval, no stt changes, twi iii, similar to prior. labs were significant for hgb 11.1 (down from 14.4), alt 46 but otherwise normal lfts, baseline chemistry panel. portal cxr showed low lung volumes with right lung atelectasis and no pleural effusion, no evidence of pneumonia. ua was +. blood and urine cultures were sent. abg 7.54/29/75/26. lactate 1.5. patient was given vanc/zosyn/levofloxacin. ct abd showed extensive gallbladder wall thickening and fat stranding toward the duodenum and pancreatic head, c/w cholecystitis. liver u/s did not show obvious stone. general surgery was consulted and did not think that patient was a surgical candidate. . upon arrival to the micu, patient is not-interactive. past medical history: - tbi secondary to anoxia during substance overdose - s/ g tube placement - s/p exploratory g tube tract incision and drainage of the retro-rectus/peri-rectus space and drain placement - s/p tracheostomy and peg placement - sepsis secondary to acute cholecystitis with placement of drain social history: according to guardian - from - h/o substance abuse, was on methadone - unclear if used etoh or smoked - no kids family history: not addressed this admission physical exam: physical exam on admission general: not interactive, not oriented heent: sclera anicteric, mmm, eomi, aniscoria left 4 mm and right 6 mm neck: supple, jvp not elevated, no lad cv: tachycardic, normal rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: coarse breath sounds, no wheezes/ronchi/crackles abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding, g-tube in place, skin around appeared erythematous/firm gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: perrla but aniscoria, gait did not examine, withdrawals from pain, decorticate posturing . discharge: vitals: 98 121/78 95 98%ra general: not interactive heent: aniscoria left pupil 4 mm and right pupil 6 mm; former lij site with no bleeding or hematoma cv: rrr, normal s1 + s2, no murmurs, rubs, gallops lungs: coarse breath sounds, no wheezes/ronchi/crackles abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding, g-tube in place, no purulent drainage. perc cholecystostomy tube in place draining greenish-brown fluid gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: decorticate posturing skin: notable for stage i sacral decub; pertinent results: labs on admission 10:15am blood wbc-12.2* rbc-3.44* hgb-11.1*# hct-33.7*# mcv-98 mch-32.3* mchc-33.0 rdw-13.7 plt ct-268 10:15am blood neuts-84.5* lymphs-10.0* monos-4.1 eos-0.8 baso-0.5 10:15am blood pt-14.9* ptt-27.6 inr(pt)-1.4* 10:15am blood ret aut-1.9 10:15am blood glucose-117* urean-35* creat-0.8 na-133 k-3.9 cl-99 hco3-23 angap-15 10:15am blood alt-46* ast-26 ld(ldh)-228 alkphos-46 totbili-0.3 10:15am blood lipase-43 10:15am blood albumin-3.0* calcium-7.9* phos-2.9 mg-2.4 iron-22* 10:15am blood caltibc-182* hapto-382* ferritn-1013* trf-140* 10:28am blood type-art fio2-35 po2-75* pco2-29* ph-7.54* caltco2-26 base xs-2 intubat-not intuba 11:00am urine color-yellow appear-hazy sp -1.024 11:00am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 11:00am urine rbc-5* wbc-46* bacteri-few yeast-none epi-0 transe-<1 11:00am urine castgr-6* casthy-2* 11:00am urine amorphx-rare caoxalx-occ 11:00am urine mucous-few micro: blood cx x2: gram positive cocci in clusters x1/4 bottles blood cx x2: pnd urine cx: 11:00 am urine **final report ** urine culture (final ): pseudomonas aeruginosa. >100,000 organisms/ml.. _________________________________________________________ pseudomonas aeruginosa | amikacin-------------- 4 s cefepime-------------- 8 s ceftazidime----------- 16 i ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem------------- 4 i piperacillin/tazo----- i tobramycin------------ 8 i sputum cx: cancelled bile cx: pnd (0pmns, 0org) c diff assay: negative urine cx: pnd blood cx: pnd . images: ct abd/pelvis with and without contrast acute cholecystitis, new from prior study. likely bibasilar atelectasis but superimposed pneumonia is not excluded. . cxr impression: right basilar atelectasis. otherwise, no acute intrathoracic process. . cta impression: 1. no pulmonary embolus to the segmental levels. 2. 2-cm right middle lobe opacity may represent focal atelectasis versus nodule. recommend 3-month follow-up ct. . - ir percutaneous chole tube . discharge labs: 06:30am blood wbc-7.1 rbc-3.97* hgb-12.9* hct-38.6* mcv-97 mch-32.6* mchc-33.5 rdw-14.0 plt ct-454* 06:30am blood plt ct-454* 06:30am blood glucose-125* urean-13 creat-0.5 na-133 k-4.5 cl-101 hco3-24 angap-13 03:59am blood alt-37 ast-30 alkphos-38* totbili-0.4 06:40am blood calcium-9.3 phos-3.9 mg-2.3 brief hospital course: summary: 52 yo m with h/o anoxic brain injury substance abuse s/p trach and peg, recent g tube placement complication s/p exploratory tract incision and drainage with replacement, who presented to micu with sepsis and transferred to floor for further management. # sepsis/sirs: the most likely source of infection was acute cholecystitis, and a drain was placed in the gallbladder. the patient completed a 7 day course of tigecycline in-house per id recommendations. he grew a pseudomonas species in his urine, which the id team felt was most likely colonization. # tachycardia: the patient was noted to be tachycardic to 140s (sinus), and was ruled out for a pulmonary embolism. he was restarted on previous doses of metoprolol after significant volume resuscitation. # lung nodule: will need follow-up ct in 3 months, pending change in overall goals of care. # anemia: improved during the course of admission, and no evidence for bleeding. # pressure ulcer: stage i, over buttock, will need good wound care and frequent repositioning. # nutrition: the patient has a history of infections at the site of his g-tube. it will be important to closely monitor the site, with routine care. this was not an active issue this admission. # code status: the patient is full code, with a court appointed guardian. changes in clinical status should be discussed with the guardian. the prognosis overall of the patient's grim chance of neurological recovery was discussed this admission, and the guardian is exploring options through the court system to potentially make the patient dnr/dni, however currently he is full code. # communication: (court appointed guardian). okay to speak with (sister ; ), (friend ) ============================== transitional issues: -needs to be taken to f/u appointment with surgery to evaluate biliary drain -pending goals of care, the patient should have repeat chest ct scan in 3 months (early ) to evaluate a lung nodule medications on admission: per record - metoprolol tartrate 50 mg every 6 hours, via g tube - colace 25 mg - heparin 5000 units tid - vitamin c 500 mg daily - famotidine 20 mg - bactrim ds 1 tab - for uti, (discharged med from prior admission for intended 10 day course) - ceftin 500 mg x 7 days - for ? - flagyl 500 mg tid x 10 days - for loose stool (diagnosed - acidophilus x 30 days ppx - iss - miralax 17 g prn - senna prn - mom 30 ml daily prn for constipation - dulcolax 10 mg suppository rectally daily prn - fleet enema 1 rectally daily prn - maalox 30 ml q6h prn discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q6h (every 6 hours). 2. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 4. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 5. vitamin c 500 mg tablet sig: one (1) tablet po once a day. 6. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 7. dulcolax 10 mg suppository sig: one (1) rectal once a day as needed for constipation. 8. fleet enema 1 enema pr prn constipation 9. oxygen therapy continuous bland aerosol mask 40 % via trach mask discharge disposition: extended care facility: highgate manor discharge diagnosis: acute cholecystitis with sepsis discharge condition: mental status: confused - always. level of consciousness: not interactive, withdraws to pain activity status: bedbound. discharge instructions: mr. was admitted for an infection, and was treated with a course of iv antibiotics to kill the infection, which likely originated from an infected gallbladder. his antibiotic course has completed. he also had a drainage catheter placed in his gallbladder, to drain the infection. . he also had a test to rule out a blood clot in the lung, called a cta of the chest, and this test was negative (there was no blood clot). . please stop previous antibiotics, including bactrim, ceftin, flagyl. it will be very important to follow-up at the scheduled surgery appointment to have the gallbladder drain evaluated. followup instructions: department: general surgery/ when: tuesday at 1:30 pm with: acute care clinic building: lm bldg () campus: west best parking: garage md procedure: enteral infusion of concentrated nutritional substances percutaneous aspiration of gallbladder central venous catheter placement with guidance diagnoses: anemia, unspecified urinary tract infection, site not specified unspecified septicemia hyposmolality and/or hyponatremia sepsis pulmonary collapse alkalosis pressure ulcer, buttock acute cholecystitis tachycardia, unspecified gastrostomy status pressure ulcer, stage i solitary pulmonary nodule personal history of traumatic brain injury 

Answer: The patient is high likely exposed to