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: pancreatic fistula - pancreatic-cutaneous fistula major surgical or invasive procedure: none history of present illness: 70m w/ gallstone pancreatitis s/p failed ercp and abdominal compartment syndrome() c/b vasodilatory sirs shock w/subsequent decompressive exploratory laparotomy (), arf, trached (), partial closure with mesh () and wound vac (). s/p drainage of pancreatic collection by ir (), lap minimally invasive pancreatic necrosectomy (, , ) for necrotizing pancreatitis. pt discharged on to rehab with pancreatic drain (chest tube into pancreatic necrotic bed). however at rehab, his pancreatic drain fell out. despite this the patient was afebrile and was doing well on his tube feeds (25-30 cc/hr). the team was informed of this on and we suggested they place an ostomy appliance over it. however healthcare workers noted increasing output from the fistula and elected to replace the tube. on , the patient was transferred from to ed for increasing fistula output as well as hypotension. 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: at time of admission: 99.4 89 79/55 20 100% tc nad tracheostomy in place, midline, secure rrr cta b s/nt/protuberant abdomen. large vac appliance to midline incision. gjtube in place. open fistula wound in l flank. mild erythema posterior to wound, likely due to skin irritation from enzymes in output. no induration or fluctuance around wound. ttp at wound site. extremities without edema picc line in left arm, peripheral iv in r hand at time of discharge: 97.3, 97, 102 (sinus tach), 112/68, 23, 100% tm 50% nad, a+ox3 trach in place, c/d/i rrr ctab soft, nt, protuberant abd. vac taken off - excellent granulation tissue over entire abdominal wound measuring approx 9" x 12", wet to dry placed with absorbant pad over wound. gj tube c/d/i, left pancreas fistula/opening covered with ostomy bag, slight surrounding erythema but no induration or fluctuance felt no c/c/e right picc line c/d/i pertinent results: admit wbc: 7.0 (2 bands) discharge wbc: 7.7 admit hct: 30 discharge hct: 25 admit cr: 2.1 discharge cr: 1.3 cultures: **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. escherichia coli. second morphology. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | ampicillin------------ <=2 s <=2 s ampicillin/sulbactam-- <=2 s <=2 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 4 s 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r =>16 r **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. moderate growth. of two colonial morphologies. escherichia coli. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | escherichia coli | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- 16 i <=1 s ceftazidime----------- 8 s <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ 4 s <=1 s meropenem------------- =>16 r <=0.25 s piperacillin---------- 16 s <=4 s piperacillin/tazo----- 32 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r catheter tip iv (left picc): no growth final imaging: ct a/p: final report indication: numerous pancreatic debridements with history notable for gallstone pancreatitis, please evaluate for pancreatic fluid collection. technique: axial ct images were acquired through the abdomen and pelvis in the absence of intravenous contrast. note that the creatinine at the time of image acquisition was 1.9. coronal and sagittal reformatted images were also reviewed. comparison: . ct abdomen without contrast: small right and trace left pleural effusions are redemonstrated, minimally changed. there are associated bibasilar consolidations, including progressed now complete atelectasis of the right lower lobe with aerosolized secretions filling the bronchus. the visualized cardiac apex reveals extensive coronary arterial calcification, as well as likely coronary arterial stents. there is no evidence of pericardial effusion. the stomach contains a percutaneous gastrojejunostomy tube which is in good position. otherwise, the stomach and duodenum are unremarkable. the adrenal glands are unremarkable. the spleen is 15.6cm in length. the collapsed gallbladder contains a calcified gallstone. the kidneys are nodular in contour, unchanged from the previous studies. numerous hepatic hypodensities are stable. there is no free gas in the abdomen and the small amount of ascites visualized previously is now largely resolved. a large pancreatic collection containing both fluid and gas is redemonstrated, difficult to precisely marginate given the absence of intravenous contrast. roughly, the overall size of the cavity appears minimally smaller than the comparison study, now approximately 131 x 32 mm (2:44), previously 147 x 39 mm. additionally, the internal components of this collection is changed with less internal gas than was previously present. the percutaneous drain in the comparison study is removed and a moderate cutaneous defect persists at the site of tube entry. peri-pancreatic fat stranding persists. pancreatic enhancement or necrosis is not assessed absent intravenous contrast. a small amount of hyperdense material is seen adjacent to the splenic flexure (2:47) in the pancreatic gas and fluid collection. this is unchanged and remains concerning for a fistula in that location. a large ventral abdominal wall defect is unchanged. regional vascular structures are notable for atherosclerotic calcification of the abdominal aorta, in the absence of aneurysmal dilation. ct pelvis without contrast: the urinary bladder contains a foley catheter. the prostate and seminal vesicles are unremarkable. the rectum contains a large amount of stool as well as oral contrast. note is made of sigmoid diverticulosis. there is no free gas or fluid in the pelvis and there is no pelvic or inguinal lymphadenopathy. note is made of bilateral fat-containing inguinal hernias. osseous findings: there is no suspicious sclerotic or lytic osseous lesion. extensive spinal degenerative changes are unchanged. impression: 1. minimal decrease in size of peripancreatic gas and fluid-containing collection with interval removal of drain. redemonstration of oral contrast within the collection, consistent with fistula from the adjacent colon. 2. progression of right lower lobe atelectasis with mucus plugging of right lower lobe bronchus. redemonstration of bilateral pleural effusions with associated atelectasis. 3. interval resolution of ascites. 4. cholelithiasis, diverticulosis, splenomegaly, unchanged. brief hospital course: after being transferred to the ed, the patient was noted to be hypotensive in the 80's. he was bolused 2 liters, placed on levaphed and transferred to the icu. his icu care will be dictated in a organ based system below: neuro: the patient's pain was well controlled. he needed minimal pain meds and only recieved intermitted dilaudid iv, mainly for vac changes. endo: patient was placed on a insulin sliding scale to maintain his blood sugars 100-120. his insulin in his tpn was adjusted accordingly. cv: his hypotension was deemed secondary to early sepsis likely from bacteremia. he was started on broad spectrum antibiotics and tailored accordingly. his hypotension resolved and the sicu team was able to wean him from his pressor requirement. he has been intermittently tachycardic (sinus) which is controlled with metoprolol iv. resp: given his sepsis early on admission, the patient was placed on pressure support early on. however as his sepsis cleared, he was weaned to trach mask which he tolerated. he continues on trach mask throughout the day without any respiratory issues. he still does require frequent trach suctioning. gi: initially his tube feeds were restarted but given his increase in his pancreas drain as well as abdominal discomfort, his tube feeds were discontinued. he was made npo in order to slow down his pancreas output and hopefully slow down the leak. in terms of nutrition he is maintained on tpn. his g-tube is to gravity and his j-tube is clamped. renal: uop was at least 30 cc/hr during his hospitalization. his ua was positive but final urine cultures did not show any growth. his cr on admission was elevated at 2.0 and during his hospitalization course trended downward 1.3. id: given his septic picture, the patient was pancultured. bcx were positive for e-coli sensitive to meropenem. sputum cx like last admission showed pseudomonas growth sensitive to meropenem. his broad spectrum antibiotics were tailored down to only meropenem. his picc line was also resited and the tip was cultured with no growth. surveillence blood cultures did not show any growth. he will continue a 14 day course of meropenem which was started on (end date ). his vac was changed multiple times. vac changes reveal excellent bed of granulation tissue and the wound appears quite shallow. he will likely need a skin graft over his wound later on in the future. he will be transferred to rehab with wet to dry dressings over his abd wound and will need a vac appliance placed (white and black foam, see discharge instructions). heme: during his icu stay, his hct drifted down from 30 to 22. he was transfused 1 unit of blood and hct increased to 25 appropriately. medications on admission: chlorhexidine 0.12% mouthwash , acetaminophen 650 pr prn, ipratropium mdi 6 puff q6h prn wheeze, white petrolatum mineral oil one application ou prn dry eyes, olanzapine 5 mg rapid dissolve prn agitation, ondansetron 4 mg iv q4h prn nausea, hydromorphone 0.4-1.0 mg q4h prn pain, lorazepam 0.5 mg iv q4h prn anxiety, metoprolol 10 mg iv q4h, riss discharge medications: 1. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q8h (every 8 hours). 2. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 3. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 4. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, t>100.4. 5. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 6. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 7. metoprolol tartrate 5 mg/5 ml solution sig: one (1) intravenous q6h (every 6 hours) as needed for hr>110. 8. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for n/v. 9. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for rash. 12. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). discharge disposition: extended care facility: new hospital discharge diagnosis: acute on chronic renal failure, pancreatic necrosis, pancreatic fistula, bacteremia, sepsis discharge condition: stable, requires vent capable facility discharge instructions: 1) dilaudid iv prn for vac changes 2) continue ssi and adjust insulin in tpn 3) metoprolol for intermittent sinus tachycardia 4) trach mask, needs frequent suctioning to clear secretions 5) no tube feeds, continue tpn 6) continue meropenem until 7) gtube to gravity 8) vac changes - 9" x 12 " abdominal wound, cover first with white foam then thin black foam then vac appliance followup instructions: please follow up with dr. in clinic in two weeks. please call the office ( to make an appointment. please call your doctor or nurse practitioner or return to the emergency department for any of the following: *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. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnoses: acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified sepsis chronic kidney disease, unspecified septicemia due to escherichia coli [e. coli] acute pancreatitis other specified diseases of pancreas tracheostomy status 

Answer: The patient is high likely exposed to