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: indomethacin attending: chief complaint: hypotension, abdominal pain major surgical or invasive procedure: pancreatic pseudocyst, jejunostomy, cholecystectomy and placement of feeding j-tube - . history of present illness: patient is a 55 year old male well known to who was recently d/c on after 1 month stay in hospital for gallstone pancreatitis complicated by respiratory and renal failure which ultimately improved with supportive care. he was discharged to rehab and was recently sent home 3 days ago. today, he awoke with a headache and complained of increasing abdominal pain. he was seen by a visiting nurse who noted that the patient appeared sweaty and diaphoretic. a blood pressure taken demonstrated a sbp in the 60's. he was sent to hospital, where bp was 70s/40s. the patient received 5l ivf resuscitation and was started on levophed and given zosyn 4.5g x1. he was transferred to for further care. past medical history: pmhx: gallstone pancreatitis, renal insufficiency recently weaned off hemodialysis, htn, asthma/copd, type ii dm, obstructive sleep apnea, eczema . pshx: , h/o spinal surgery social history: lives alone. drinks a few beers a week. quit smoking in . family history: non-contributory physical exam: on admission: vs: t 97.2 hr 84sr bp 104/68 rr 18 spo2 95-96% general: awake and alert cv: rrr lungs: cta bilaterally abdomen: soft, obese/protuberant, diffusely tender but greatest in llq and ruq, no rebound or guarding ext: warm, 2+ peripheral edema, 2+ dp pulses bilaterally . at discharge: vs: 98.4 po, 74, 114/58, 18, 96% ra gen: well appearing in nad. heent: sclerae anicteric. o-p clear. neck: supple. lungs: cta(b) cor: rrr abd: midline incision with staples with mild surrounding erythema, otherwise c/d/i. no drainage or exudate. (r) and (l) prior jp sites (now discontinued) intact and healing. (l) abdominal j-tube clamped; insertion site intact. bsx4. mild distension. appopriately tender to palpation along incision, otherwise soft/nt. extrem: no c/c/e neuro: a+ox3. non-focal/grossly intact. pertinent results: on admission: 07:30pm glucose-152* urea n-25* creat-1.4*# sodium-137 potassium-4.3 chloride-106 total co2-25 anion gap-10 07:30pm alt(sgpt)-29 ast(sgot)-27 ck(cpk)-16* alk phos-87 tot bili-0.8 07:30pm lipase-5 07:30pm ctropnt-0.05* 07:30pm albumin-2.6* calcium-7.6* phosphate-4.8* magnesium-1.5* 07:30pm wbc-8.4 rbc-3.44* hgb-9.8* hct-30.3* mcv-88 mch-28.6 mchc-32.5 rdw-14.0 07:30pm neuts-83.8* lymphs-10.0* monos-3.5 eos-2.3 basos-0.3 07:30pm plt count-240 07:30pm pt-20.7* ptt-45.2* inr(pt)-1.9* 07:30pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 07:30pm urine color-yellow appear-clear sp -1.017 07:30pm urine rbc-0-2 wbc- bacteria-occ yeast-none epi-<1 07:30pm urine hyaline-0-2 . imaging: ap chest: no acute findings. persistent bibasilar opacities, likely atelectasis vs. small effusions. . abd/pelvic ct w/o contrast: 1. findings progressed from prior study, compatible with pancreatic necrosis with phlegmonous collection in the pancreatic bed containing trapped gas. the possibility of superinfection cannot be excluded. 2. small volume ascites, unchanged. 3. cholelithiasis. 4. cbd stent in appropriate position. 5. small bilateral pleural effusions, stable. . ap chest: right internal jugular line is now in central position. subsegmental atelectasis. evidence for accumulation of small bilateral pleural effusions and possible development of mild vascular congestion as well. . bilat lower ext veins: 1. focal occlusive thrombus in the right cephalic vein around the peripheral iv catheter. no proximal extension. 2. no dvt in the deep veins. . ct abd w&w/o contrast; pelvic ct w/contrast: 1. necrotizing pancreatitis with large collection of air and necrosed tissue in the pancreatic bed involving whole pancreas measuring 8.7 x 17 x 13 cm, which is stable as compared to the previous examination. 2. stent in the cbd in appropriate placement. 3. gallbladder stones and small amount of air. 4. splenomegaly. 5. moderate amount of peritoneal fluid which has increased in size as compared to the previous examination. 6. bilateral moderate-sized pleural effusions which have also increased in size compared to the previous examination. . cxr: small bilateral pleural effusions are stable. bibasilar atelectases have increased on the left side. cardiomediastinal contours unchanged. cardiac silhouette is partially obscured by the pleural parenchymal abnormalities. the upper lungs are grossly clear. . cxr: one portable view. comparison with the previous study of . there is streaky density of the lung bases consistent with subsegmental atelectasis. the costophrenic sulci are blunted. the left hemidiaphragm is indistinct. mediastinal structures are unchanged. a nasogastric tube and left subclavian catheter have been removed. a picc line has been inserted on the left and terminates in the superior vena cava. there is no other significant change. . microbiology: 9:20 am tissue pancreatic necrosis. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. smear reviewed; results confirmed. tissue (final ): reported by phone to dr. on at 12:00. identification and sensitivity testing on all organisms requested by dr.. klebsiella oxytoca. moderate growth. enterobacter cloacae. sparse growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. enterococcus sp.. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella oxytoca | enterobacter cloacae | | enterococcus sp. | | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin--------- 2 i 0.5 s gentamicin------------ <=1 s <=1 s linezolid------------- 2 s meropenem-------------<=0.25 s <=0.25 s penicillin g---------- 8 s piperacillin/tazo----- <=4 s 8 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s vancomycin------------ =>32 r anaerobic culture (final ): no anaerobes isolated. brief hospital course: the patient was transferred from hospital and admitted to the via the ed on for further evaluation and treatment of hypotesion. in the ed, his initial vital signs were t 97.2 hr 84 bp 104/68 rr 18 o2 95-96%. he was continued on norepinephrine. a ct abd was performed which showed findings compatible with pancreatic necrosis with phlegmonous collection in the pancreatic bed containing trapped gas as well as cholelithiasis. . - : 1. respiratory failure: the patient was intubated this morning due to tachypnea and hypoxia in the setting of receiving many liters of ivf while oliguric. cxr to confirm ett placement. weaned his fio2 as tolerated. increasing peep seemed to decrease his oxygen sat so will aim to keep his peeps in the mid-range. serial abgs were checked to assess ventilation. propofol and fentanyl prn for sedation. he was readily extubated prior to transfer to the floor. . 2. gallstone pancreatitis: the patient presented with pancreatitis and was found to have a cbd stone. he was medically treated for pancreatitis with bowel rest and ivf, however he has clinically continued to worsen and his amylase has continued to rise raising concern that the stone is still causing blockage and damage to the pancreas. fellow consulted regarding to evaluate for persistent pancreatic blockage. surgery consulted. npo with ivf. trend lft's and pancreatic enzymes. . 3. hypotension: patient became hypotensive during transport and after arrival to the . likely due to a combination of his sedation, hypocalcemia, and high peep. also could be secondary to sepsis given a possible biliary source for infection. repleted hypocalcemia with calcium gluconate. will trend and replete prn. levophed prn to maintain maps>65. will follow cvp and continue with aggressive ivf (lr) fluid repletion given 3rd spacing physiology with pancreatitis. will try to keep peep < 15 if possible. sending blood cultures, ua, and ucx. zosyn, renally dosed due to concern for possible cholangitis. . 4. acute renal failure: the patient per osh records had normal renal function at baseline. over the past few days his cr has increased to 4.2 and his urine output has dropped off. in the setting of pancreatitis with significant third-spacing and hypotension he likely has oliguric atn. also in the differential is postrenal and other intrarenal causes such as ain. will consult renal as he may need cvvh in the near future if he remains oliguric and his k continues to rise. will check urine lytes. trend creatinine. renal us to rule out postrenal cause. renally dose medications and avoid nephrotoxins. . 5. hyperglycemia: the patient does not have known history of diabetes, however was found to have sugars in the 500's at the osh so he likely had underlying type ii diabetes. he was weaned off the insulin gtt prior to transfer. unfortunately there is no documentation sent with the amount of insulin he received over the last 24 hours. will check q6h fingersticks and cover with ssi. will add up his 24 hour requirements and start a long-acting . . 6. anemia: the patient's hct is 39.8. no clinical evidence of bleeding. likely secondary to his acute illness. active type and screen. continue to trend. guaiac stool. . 7. thrombocytopenia: his platlets are 136 which is stable from his values at the osh. were 202 on admission. continue to trend. . 9 course - : the patient was transferred to the general surgery service on . he remained npo except medications for bowel rest, on iv fluids, with a foley catheter in place, and was given dilaudid iv prn for pain control with good effect. he was placed on contact precautions as the standard mrsa screen performed in the was positive. also, the team was contact on that a urine culture performed at the outside hospital grew vre. the patient was hemodynamically stable. . given expected prolonged npo status, a picc line was placed, and tpn started on . the foley catheter was discontinued on ; the patient subsequently voided without problem. abdominal/pelvic ct revealed necrotizing pancreatitis with large collection of air and necrosed tissue in the pancreatic bed involving whole pancreas measuring 8.7 x 17 x 13 cm, which is stable as compared to the examination. moderate amount of peritoneal fluid which has increased in size as compared to the previous examination. pre-operative screening and labwork was completed. on , the patient was brought to the operating room. . post-operative course - : on , the patient underwent ancreatic pseudocyst jejunostomy,necrosectomy, cholecystectomy and placement of feeding j-tube, which went well without complication (reader referred to the operative note for details). in the or, 2400ml of ascites was found, ebl 300ml, received 4l ivf, and received 2 units prbcs. after a brief, uneventful stay in the pacu, the patient was admitted to the ticu npo with an ng tube, intubated on mechanical ventilation, on iv fluids, with a foley catheter and two jp drains in place, a j-tube to gravity drainage, and fentanyl iv for pain control. the patient was hemodynamically stable. decreased urine output immediately postoperatively responded well to albumin. on pod#1, the patient extubated easily. tpn continued with insulin increased in tpn. dilaudid pca started. patient oob to chair. intra-abdominal collection culture growing 2 types of gnr + likely enterococcus; patient started on iv vancomycin. the patient was transferred to the inpatient floor on . . neuro: post-operatively, he was placed on a fentanyl iv drip in the ticu, then a dilaudid pca on the floor with good pain control. when tolerating oral intake, the patient was transitioned to oral pain medications with continued good effect. he remained neurologically intact during admission. . cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. . pulmonary: patient experienced shortness of breath and rales on examination. cxr revealed findings consistent with bibasilar atelectases. the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. . gi: post-operatively, patient had two jp drains and a j-tube. left jp discontinued due to low output on . j-tube was initially to gravity drainage, the tubefeeds were started. once tube feeds discontinued, the j-tube was clamped. right jp, which had been putting out over 1 liter daily, was discontinued on . the patient denied abdominal pain, bloating, and did not experience abdominal distension. by discharge, patient was tolerating his diet, passing flatus, and having formed bowel movements. . gu/fen: post-operatively, the patient was npo on iv fluid and continued on tpn. patient was weaned off tpn on , and the patient started on trophic tube feeds via the j-tube. the j-tube feeds were progressively advanced to goal with good tolerability, but the patient experienced severe diarrhea. on , the patient was started on sips of clears. diet was progressively advanced to a diabetic, heart healthy regular by , which was well tolerated. given patient's excellent oral intake and probable tubefeed-related diarrhea, tubefeeds were discontinued on . 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: cultures of tissue from the pancreatic cyst taken during the surgery were sent and grew klebs oxytoca, enterobacter and enterococcus. he was initially started onto meropenem 500 mg iv q6h and vancomycin 1000 mg iv q 12h. transitioned to meropenem monotherapy on with plans to transition to ertapenem for four week course after discharge. the patient received and tolerated his initial dose of ertapenem prior to discharge. serial cdiff screens when patient experiencing diarrhea were negative; diarrhea related to tubefeeds. the patient's white blood count and fever curves were closely watched for signs of infection. wound: mid-abdominal incision with staples with mild surrounding erythema; continued on antibiotic therapy. staples will be removed at follow-up appointment. precautions: routine mrsa screening was positve on . outside hospital urine reported positive for vre on (also resistant to levofloxacin, nitrofuratoin, and cipro). patient placed on contact precautions. repeat urine cx revealed no growth. . endocrine: the patient's blood sugar was monitored throughout his stay; sliding scale insulin was administered accordingly and lantus insulin added to the regimen. insulin in tpn was adjusted as well. the patient was discharged on lantus 10units sq qhs as well as a humalog insulin sliding scale. . hematology: the patient's complete blood count was examined routinely; the patient received 2 units of prbcs in the or, but did not require further transfusions. . 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 a diabetic, heart healthy regular diet, ambulating, voiding without assistance, and pain was well controlled. (l) abdominal j-tube was clamped. picc line was patent and intact. he was discharged to an extended care facility for further management. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. glipizide 10 mg tablet sig: one (1) tablet po twice a day. 3. renagel (now discontinued) 4. nephrocaps (now discontinued) 5. neurontin 6. naprosyn 250-500mg po bid discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. amylase-lipase-protease 60,000-12,000- 38,000 unit capsule, delayed release(e.c.) sig: two (2) cap po tid w/meals (3 times a day with meals). 3. glipizide 10 mg tablet sig: one (1) tablet po twice a day. 4. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 6. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 7. lantus 100 unit/ml solution sig: ten (10) units subcutaneous at bedtime. 8. insulin lispro 100 unit/ml solution sig: 2-22 units subcutaneous as directed per humalog insulin sliding scale. 9. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. ertapenem 1 gram recon soln sig: one (1) gram intravenous once a day for 4 weeks. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain. 12. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. discharge disposition: extended care facility: senior care center discharge diagnosis: 1. necrotizing pancreatitis and gallstones. 2. renal insufficiency 3. type ii dm discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: *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. 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. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water or saline. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. . j-tube care: *clamped. *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 insertion site gently with warm, soapy water or saline. place a drain sponge. change daily and prn. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the j-tube attached securely to your body to prevent pulling or dislocation. *flush j-tube with 30ml water tid. followup instructions: provider: 2 (st-4) gi rooms date/time: 1:00 provider: , md phone: date/time: 1:00 . provider: , md phone: date/time: 10:00 . please call ( to schedule a follow-up appointment with dr. (surgery) in 10 days. . please call ( to arrange a follow-up appointment with dr. (pcp) in weeks. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances arterial catheterization cholecystectomy presacral sympathectomy internal drainage of pancreatic cyst diagnoses: thrombocytopenia, unspecified hypocalcemia obstructive sleep apnea (adult)(pediatric) anemia, unspecified acute kidney failure with lesion of tubular necrosis unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis pulmonary collapse septic shock infection with microorganisms without mention of resistance to multiple drugs methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site obesity, unspecified chronic obstructive asthma, unspecified acute pancreatitis cyst and pseudocyst of pancreas calculus of gallbladder and bile duct without cholecystitis, with obstruction other suppurative peritonitis 

Answer: The patient is high likely exposed to