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: patient recorded as having no known allergies to drugs attending: chief complaint: transferred from ohs for management of acute necrotizing pancreatitis and respiratory failure major surgical or invasive procedure: percutaneous gallbladder drain placement drain reinsertion broncheal lavage thoracocentesis history of present illness: 27 yo male with pmh significant for etoh abuse and peptic ulcer who was admitted to the hospital on for abdominal pain, nausea and vomiting. he was found to have pancreatitis with lipase at 2946 at presentation. he was initially treated on medicine floor with iv fluids and pain meds. he then became hypotensive and tachycardic. they thought this was related to etoh withdraw there was a question of aspiration and sirs. there was concern for airway protection and he was intubated. initially thought to have evolving ards. he was given fluids and pressors. he self extubated on and was placed on bipap intermittently. he had abd ct studies that showed extensive swelling of the pancreas with extensive fluid in the peripancreatic tissue. he was initially febrile and was started on vanco, flagyl, imepenem. as per notes he has not been febrile in the last few days. he had increase abdominal distention consistant with ascitis and had a paracentesis on which showed greenish/brownish fluid with amylase 68, glucose of 132, ldh 1585, which were concerning for necrotizing pancreatitis. there is no diff of the peritoneal fluid. both blood and peritoneal cultures are still pnd. as per discharge summary pt was hemodynamically stable with bp 130/90, rr 24 and 100% on non rebreather prior to discharge. today's his amylase is 47, lipase 80, ggt 289, t.bili 1.6 na 137, k 4.5, creatine of 0.6. his wbc 23,000, hct 30, plts 307k. he also developed with creatine 3.4 which has improved. on arrival, he was a+o x3 very anxious with increase wob, rr 40s, o2 sat 100% on non-rebreather. hr 120 sinus tachy, bp 142/88, temp 99.7. he was then intubated due increase work of breathing. during intubation he desated for a few seconds to 50s% and quickly recovered to 100% while intubated. he was awake and required increased amounts of sedation. past medical history: gastric ulcer disease requiring egd in with clipping etoh abuse social history: pt lives alone. both mother and father are very involved on his care. he drinks on average 4-5 drinks of whiskey per day 4-5x wk. he does not smoke, and has used marijuana in college, but denies using any other illicit drugs family history: cad father at age of 62 physical exam: vitals: temp 99.7, hr 120s-160s sinus tachy, bp 142/88, rr 40s 100% on non-rebreather general: increase wob and anxiety heent: sclera mildly icteric, dry mm, oropharynx clear neck: supple, no jvd, no lad lungs: shallow breathing with diminished bs at bases, upper and central rhonchi, no wheezes crackles cv: +s1 + s2, no murmurs, rubs, gallops, +tachycardia abdomen: tense, non-tender, distended with ascitis, +bowel sounds, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses,no edema in bilateral le neuro: a+ o x3 pertinent results: at admisson: lipase 2946, amylase 249, tg 2715. , ggt 4182, tbili 2.7, alt 148, ast 285, alk phos 321 discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:56 13.1* 2.65* 7.9* 24.7* 93 29.9 32.0 16.5* 937* admission labs: 10:45pm blood wbc-21.3* rbc-3.35* hgb-10.3* hct-31.4* mcv-94 mch-30.8 mchc-32.9 rdw-16.0* plt ct-419 10:45pm blood neuts-89* bands-4 lymphs-2* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-1* 10:45pm blood hypochr-1+ anisocy-1+ poiklo-1+ macrocy-1+ microcy-normal polychr-1+ ovalocy-1+ schisto-1+ 10:45pm blood pt-14.5* ptt-28.7 inr(pt)-1.3* 04:03am blood plt ct-1065* 04:13am blood plt smr-very high plt ct-1263* 10:45pm blood glucose-141* urean-12 creat-0.6 na-140 k-4.4 cl-103 hco3-25 angap-16 10:45pm blood alt-21 ast-33 ld(ldh)-658* alkphos-80 amylase-36 totbili-1.2 04:31am blood alt-12 ast-43* ld(ldh)-319* alkphos-243* totbili-2.9* dirbili-2.3* indbili-0.6 05:31am blood alt-18 ast-47* alkphos-385* totbili-4.0* 11:45pm blood alkphos-492* totbili-4.1* 05:06am blood alt-20 ast-44* ld(ldh)-221 alkphos-500* totbili-3.8* 04:31am blood alt-15 ast-37 alkphos-653* totbili-2.1* 04:09am blood caltibc-105* vitb12-1156* folate-11.0 ferritn-greater th trf-81* 10:45pm blood triglyc-293* 04:13am blood tsh-3.0 09:07pm blood type-art po2-122* pco2-35 ph-7.48* caltco2-27 base xs-3 microbiology: aspergillus galactomannan antigen test result reference range/units aspergillus antigen 1.2 h <0.5 result interpretation: sera with an index <0.5 are considered to be negative. sera with an index >=0.5 are considered to be positive . b-glucan test ---- fungitell (tm) assay for (1,3)-b-d-glucans results reference ranges ------- ---------------- <31 pg/ml negative less than 60 pg/ml indeterminate 60 - 79 pg/ml positive greater than or equal to 80 pg/ml aspergillus galactomannan antigen test result reference range/units aspergillus antigen 0.1 <0.5 result interpretation: sera with an index <0.5 are considered to be negative. sera with an index >=0.5 are considered to be positive. , , , , , , blood culture: no growth. 10:46 pm urine source: catheter. no growth 10:17 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and chains. respiratory culture (final ): sparse growth commensal respiratory flora. 11:20 pm catheter tip-iv source: r cvc. **final report ** wound culture (final ): no significant growth. 10:48 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs. respiratory culture (final ): sparse growth commensal respiratory flora. **final report ** urine culture (final ): no growth. 11:43 pm stool consistency: not applicable source: stool. **final report ** fecal culture (final ): no enteric gram negative rods found. 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). 11:45 am catheter tip-iv source: aline. **final report ** wound culture (final ): no significant growth. 12:01 am sputum source: endotracheal. **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): sparse growth commensal respiratory flora. 1:01 pm blood culture ( myco/f lytic bottle) source: line-cvl. blood/fungal culture (preliminary): no fungus isolated. blood/afb culture (preliminary): no mycobacteria isolated. 3:40 am blood culture source: line-cvl- tpn line. **final report ** blood culture, routine (final ): enterococcus faecium. final sensitivities. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: resistant to 1000mcg/ml of streptomycin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. . daptomycin = sensitive ( 1.5 mcg/ml ). daptomycin sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecium | ampicillin------------ =>32 r linezolid------------- 2 s penicillin g---------- =>64 r vancomycin------------ =>32 r anaerobic bottle gram stain (final ): reported by phone to @ 1030pm . gram positive cocci in pairs and chains. aerobic bottle gram stain (final ): gram positive cocci in pairs and chains. 12:11 pm bronchoalveolar lavage gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. fungal culture (preliminary): no fungus isolated. 7:29 pm bile **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 1:01 am catheter tip-iv source: right ij triple lumen. **final report ** wound culture (final ): no significant growth. 10:28 am blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 6:07 am blood culture source: venipuncture. blood culture, routine (pending): 4:16 pm bile gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. 3:00 pm peritoneal fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. 3:09 pm pleural fluid **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. pleural pleural analysis wbc rbc polys lymphs monos eos meso macro other 15:09 370* 2325* 16* 28* 33* 4* 1* 17*1 1*2 several signet forms noted reactive mesothelial cells reviewed by pleural chemistry totprot glucose creat ld(ldh) amylase albumin 15:09 3.5 113 0.4 186 15 1.8 ascites ascites analysis wbc rbc polys lymphs monos eos mesothe macroph 14:17 315* 410* 12* 17* 0 1* 2* 68* source is peritoneal fluid ascites chemistry amylase totbili misc 15:11 24 1.9 lipase = 21 ct abdomen and pelvis : 1. a large amount of ascites in the abdomen and pelvis, as before. there is increased enhancement of the margins of fluid in both flanks with areas of loculation. 2. new area of enhancing perihepatic fluid adjacent to the lateral margin of the right hepatic lobe, which may represent a biloma following prior cholecystostomy. 3. the cholecystostomy tube now lies in the right anterior abdominal wall, with a small portion in the subcapsular portion of the right hepatic lobe. the gallbladder is not distended, and contains intraluminal debris. 4. no pe is seen. large bilateral pleural effusions have slightly increased in size. echo : the left atrium and right atrium are normal in cavity size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the left ventricular systolic function is less vigorous, but still normal. brief hospital course: 27 yo male who was admitted from outside hospital icu initially admitted on and transferred to our micu on with alcoholic necrotizing pancreatitis and ards. he was extubated twice once in outside hospital and once in the our icu he became tachypenic and was unable to protect his airway, so he was reintubated. he was intubated on the vent in our hospital for > 10 days and transitioned to trach. #pancreatitis: he developed necrotizing pancreatitis complicated with ards. he was weaned off vent, ultimately to trach collar on room air. he received meropenem for 10 days, stopped on . he had diffuse abdominal inflammation and ascites thought to be due to his pancreatitis. he had gallbladder, pleural, and peri-hepatic fluids therapeutically and diagnostically drained. he had bowel rest with tpn and ultimately transitioned to -jejunal tube feeds. surgery closely followed pt throughout hospital course. will follow-up with surgery, dr. , to asses his progress and repeat ct - details on page 1. # pulmomary embolus: pt was diagnosed with pe on ct scan which showed probable pe versus motion artifact: lenis were negative. started on heparin drip then switched to lovenox. repeat chest cta done on did not show a pe, however this was difficult to interpret since he was already treated for 7 days with lovenox and clot might have been absorbed. he continued on lovenox and started coumadin during admission. he will need to continue lovenox until he is therapeutic in inr (goal ) for at least 48 hours. at that time, he can be maintained on coumadin. # bacteremia: pt had vanco resistent eneteroccocus from culture, antibiotic switched from vanco to linezolid started on with a 14 day course (to be completed by .). he had fevers much of his stay which eventually trended down with antibiotics. on discharge, he was asymptommatic, afebrile and hemodynamically stable. picc line was removed prior to discharge, tip was not sent for culture. #c. diff: pt had positive c. diff toxin from outside hospital. he was started on flagyl (took 15 day course) then switched to po vancomycin (will continue until 2 weeks after broad spectrum antibiotics are stropped). # hypoxemic respiratory failure: pt likely developed ards in the setting of pancreatitis. pt was treated with 14 day course of and vanco and 8 day course of levo for aspiration/hap pna. after extubation, he aspirated and was covered broadly with vanc/zosyn for 7 + days which was d/ced on . pt was briefly treated with micafungin for 6 days for + b-galactamanan, but repeat test was negative so it was stopped. pt continued with linazolid with stop date on . # vent: pt weaned off vent after around 30 days and ultimately transitioned to trach collar. on day of discharge, he was comfortable on trach collar room air, able to talk with passe-muir valve. #delerium and sedation: pt experienced delerium thought to be secondary to his high doses of narcotics and benzos for sedation while intubated for 30 days. he was given haldol and tapered methadone which improved his mental status. his delerium gradually improved dramatically over the course of his hospitalization and he was lucid, conversant, ambulatory by the day of discharge. #nutrition: was on tpn and transitioned to tube feeds -jejunal tube. a few days prior to discharge, he was tolerating a soft food diet. #tachycardia: pt was tachycardic in the 120-130s most of his admission. it was initially thought that his tachcyardia was secondary to withdrawel from sedation and optiod administration for the entire month that he was ventilated. however, fluid boluses, methadone and benzos did not help. we ultimately put him on beta blockers carvedilol 6.25 to rate control him and prevent tachycardia induced cardiomyopathy. carvedilol should be titrated to hr in 100-120's as bp will tolerate. medications on admission: medications at transfer: imipenem 500mg iv q 8 hrs flagyl 500mg q8hrs vancomycin 1000mg q8hrs lactobacillus mvi promethazine prn zofran nebulizers: duoneb dexmedetomidine infusion at 0.5mcg/kg per hour protonix 40mg qday discharge medications: 1. vancomycin 250 mg capsule : 500mg capsules po q6h (every 6 hours): last day - continue for 14 days after last dose of linezolid. . 2. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day): continue as long as pt is on trach. 3. enoxaparin 80 mg/0.8 ml syringe : 80mg subcutaneous q12h (every 12 hours): can switch to oral coumadin. . 4. acetaminophen 325 mg tablet : 650mg tablets po q6h (every 6 hours) as needed for pain/fever. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : 30mg tablet,rapid dissolve, drs (daily). 6. nystatin 100,000 unit/ml suspension : 5ml mls po qid (4 times a day) as needed for thrush: for oral thrush. swish and swallow 4 times a day. 7. trazodone 50 mg tablet : 25mg tablets po hs (at bedtime) as needed for sedation: for sleep if needed. 8. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical qid (4 times a day) as needed for rash: for rash on leg. 9. linezolid 600 mg tablet : 600mg tablets po q12h (every 12 hours): take through . 10. folic acid 1 mg tablet : one (1) tablet po once a day. 11. thiamine hcl 100 mg tablet : one (1) tablet po once a day. 12. carvedilol 6.25 mg tablet : one (1) tablet po bid (2 times a day). 13. warfarin 5 mg tablet : one (1) tablet po daily (daily): discharge disposition: extended care facility: discharge diagnosis: necrotizing pancreatitis ards - acute respiritary failure pneumonia vancomycin resistent enterococcus bacteremia pulmonary embolism clostridium difficile diarrhea tachycardia discharge condition: mental status: clear and coherent. discharge instructions: you will go to a rehab center to continue your care for alcoholic pancreatitis and respiratory failure. you were admitted to the hospital for over a month for treatment of alcoholic pancreatitis and respiratory failure. you were very sick and required a machine to help you breath for about one month. eventually, we transitioned you to a tracheostomy (hole in your neck for breathing) to continue to protect your lungs as you improved. we gave you antibiotics for infections of your blood and abdomen which must be continued after discharge as listed below. your pancreas was very inflamed causing fluid build up in your abdomen and lungs, requiring drainage. you also had a blood clot in one of your veins and were started on a blood thinner, lovenox (shot) and warfarin (pill). it is important that you have your warfarin level checked as instructed by your physician once you leave rehab. you clinically improved throughout the hospital course and are ready for your next step in treatment at a rehabilitation center. changes in medication: please start all medications as listed on your discharge paperwork. you were not admitted to the hospital on any medications. followup instructions: dr. appt and ct on : ct scan at 9am. provider: , md phone: date/time: 11:15am. md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube insertion of endotracheal tube thoracentesis percutaneous abdominal drainage percutaneous abdominal drainage other bronchoscopy temporary tracheostomy closed [endoscopic] biopsy of bronchus percutaneous aspiration of gallbladder injection or infusion of oxazolidinone class of antibiotics diagnoses: anemia, unspecified esophageal reflux unspecified pleural effusion hypopotassemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis bacteremia intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation paralytic ileus other specified disorders of biliary tract other ascites streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] other and unspecified infection due to central venous catheter acute cholecystitis drug-induced delirium drug withdrawal other and unspecified alcohol dependence, unspecified other pulmonary embolism and infarction other abnormal blood chemistry acute pancreatitis other abnormal glucose alcohol withdrawal dependence on respirator, status other specified analgesics and antipyretics causing adverse effects in therapeutic use benzodiazepine-based tranquilizers causing adverse effects in therapeutic use combinations of opioid type drug with any other drug dependence, unspecified essential thrombocythemia 

Answer: The patient is high likely exposed to