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: history of present illness: ms is a 61 year old woman with past medical history significant for gastroesophageal reflux disease and alcohol abuse. her history is also significant for an extended left gastrointestinal bleed in and consequent ileostomy takedown. previously in she required a right colectomy for a perforated colon and had an ileostomy placed in the right upper quadrant. the patient has been in her usual state of health until the night before admission when she developed sudden diffuse abdominal pain followed by bilious emesis. the pain did not improve and the patient presented to the emergency room. in the emergency room she was found to be tachycardiac with abdominal pain and bilious emesis. the patient did not report any fevers or chills or diarrhea. she reported good ostomy output until at least the evening before the day of admission. in the emergency room a nasogastric tube was placed and a kub was obtained which revealed no free air but did show a focal ileus or possible early obstruction. an abdominal computerized tomography scan was recommended for further evaluation of the etiology of her abdominal pain. the patient was admitted to general surgery for further observation and a possible surgical intervention pending more studies. past medical history: 1. hypertension; 2. alcohol abuse; 3. gastroesophageal reflux disease; 4. small bowel obstruction. past surgical history: 1. extended left hemicolectomy, appendectomy and a diverting ileostomy for a lower gastrointestinal bleed in ; 2. takedown of the ileostomy in ; 3. right colectomy for perforated colon and ileostomy placement in . social history: history of alcohol abuse and history of smoking. medications on admission: 1. lopressor 50 mg p.o. b.i.d.; 2. prilosec; 3. remeron; 4. wellbutrin; 5. oxycontin. physical examination: afebrile, heartrate 150, blood pressure 155/81, 18 respiratory rate, 100% on room air. the patient was alert and oriented but appeared uncomfortable due to pain. there was no evidence of jaundice. head, eyes, ears, nose and throat examination, her sclera were nonicteric and her mucous membranes were dry. lungs were clear to auscultation bilaterally. cardiac examination, tachycardiac with regular rhythm and no murmurs, rubs or gallops. abdominal examination, a healthy looking pink ileostomy in the right upper quadrant. her midline incision was without hernias. there were no masses felt. there was a diffuse tenderness in the right upper quadrant and mid epigastrium with rebound and guarding which was thought to be consistent with probable peritonitis. rectal examination, a hard mass was felt which felt to be likely a foreign body present in the rectum. pelvic examination, within normal limits. extremities, warm, well perfused, no signs of edema. laboratory data: white blood cell count 14, hematocrit 40.6, platelets 246, neutrophils 87%, sodium 139, potassium 2.7, bun 9, creatinine 0.7, glucose 117, inr 3.1. ast 18, alt 13, alkaline phosphatase 87, total bilirubin 0.7, albumin 4.4, lipase 316, amylase 190. imaging studies: kub obtained in the emergency room showed focal ileus or possible early obstruction. hospital course: the patient continued to have severe abdominal pain without much relief. she has been having normal bowel movements through her ileostomy, however. a follow up abdominal computerized axial tomography scan was obtained given nonconclusive findings of the kub which revealed fluid and free air in the lesser sac which at that time was thought to be consistent with a possible perforated posterior gastric or duodenal ulcer. she also secondarily appeared to have pancreatitis. given the above findings, the patient was taken to the operating room for a probable perforated viscous. on , the patient underwent exploratory laparotomy with extensive lysis of adhesions. of note is that the entire bowel from the esophagus to the end ileostomy was visualized and there was no evidence of perforation, only the saponification which was most consistent with pancreatitis. please see the full operative note for details. the patient was transported to the post anesthesia care unit intubated. she was consequently transferred to the intensive care unit for further management. she was resuscitated with intravenous fluids. her urine output was closely monitored. she was started on ampicillin, gentamicin and flagyl. postoperatively a drain was left in the retroperitoneum as well as a second drain was placed anterior to the duodenum and pancreas. however, on postoperative day #1 her anterior drain was noted to be bile stained. the patient was consequently brought back to the operating room for an exploration for possible enterotomy at the time of her exploration or possibly an undiagnosed perforated viscous. therefore, on the patient was taken back to the operating room for an exploratory laparotomy and the oversew of the duodenal perforation and the placement of a jejunostomy tube. the findings were consistent with a duodenal perforation and pancreatitis. please see the full operative note for details. the patient remained intubated and was transported to the intensive care unit. on postoperative day #2, the patient spiked a fever of 101.3. her heartrate remained in the low 100s with her blood pressure slightly elevated. the abdominal wound swab showed escherichia coli and enterococcus taken on . the escherichia coli was pansensitive and enterococcus was sensitive to vancomycin but resistant to ampicillin and levofloxacin. blood cultures showed no growth. the nasogastric tube remained in place. the respirator support was gradually weaned. she maintained good urine output and had stable hematocrit. the tube feeds were started and advanced to goal rate. the pain was controlled with dilaudid. the tachycardia and hypertension were controlled with lopressor and clonidine. the patient was no longer febrile. she was successfully extubated. she was maintained on a brief course of imipenem until sensitivities came back. the urine culture from grew yeast. the patient was encouraged to use the incentive spirometer. a chest x-ray obtained on showed new bilateral small to moderate sized pleural effusions. the total parenteral nutrition was eventually discontinued and the patient was just maintained on tube feeds. due to a persistent lowgrade fever and elevated white count an abdominal computerized tomography scan was obtained on . the abdominal computerized tomography scan demonstrated multiple abscesses within the abdomen including an abscess located between the head of the pancreas and the duodenum as well as a fluid collection located in the left upper quadrant near the proximal jejunum. on , the patient underwent another expiratory laparotomy given the finding of multiple abscesses. the intra-abdominal drain was repositioned. the patient tolerated the procedure well. there were no complications. please see the operative note for details. the patient was transferred back to the intensive care unit. she remained intubated. her acidosis was corrected. the total parenteral nutrition was continued. a pigtail catheter was placed by ct scan for further fevers and a small collection noted near the pancreas. after placement, it appeared to drain frank bile. it was repositioned on as it appeared to be intraluminal. the antibiotics were changed to levaquin, fluconazole and vancomycin. the abscess culture obtained on grew corynebacterium species as well as pseudomonas species. the pseudomonas was pansensitive. the sputum gram stain and culture obtained on grew pseudomonas and klebsiella with klebsiella being pansensitive as well. the antibiotics were adjusted accordingly. the patient was finally extubated on . her antibiotics at that time were vancomycin, ciprofloxacin, fluconazole and flagyl. the - drains were putting out a moderate amount of discharge. the nasogastric tube remained in place with a moderate amount of drainage. a picc line was placed by interventional radiology on for the need of total parenteral nutrition. the abdominal incision remained slightly opened with wet to dry dressings applied. it gradually was granulating. a repeat abdominal computerized axial tomography scan on showed stable appearance of the abdomen with free fluid in the hepatorenal space and onto the liver. there were several small locules of fluid noted adjacent to the pancreas, the largest of which was noted to be lying in the tail of the pancreas. the surgical drains were noted to be lying adjacent to the loculated collections. the patient was eventually transferred to the regular floor out of the intensive care unit. physical therapy was consulted. the patient was maintained on ceftaz, fluconazole, and gentamicin. her blood pressure was controlled with lopressor. she was receiving reglan through the jejunostomy tube. her total parenteral nutrition was discontinued and she was just maintained on tube feeds which were being cycled to meet her goal needs. the patient continued to do well. she remained afebrile. repeat blood cultures were sent on which showed no growth. a catheter tip from central line was sent as well which showed no growth. the - drain fluid was sent again to microbiology on which again grew pseudomonas resistant to ciprofloxacin but sensitive to everything else and enterococcus resistant to ampicillin, levofloxacin and penicillin but sensitive to vancomycin. nutrition continued to follow the patient during her hospitalization. the abdominal wound continued to improve without any evidence of cellulitis. granulation process continued. there was no evidence of pus or any other signs of infection. the repeat blood cultures on were obtained in response to a temperature spike to 103.5. the patient otherwise remained asymptomatic. the white blood cell count peaked at 12.2 but stabilized at 10. the central line was changed over a wire as a possible cause of her fever on . the patient continued to do well. she was ambulating. her oral intake was moderate but she tolerated food well. the patient was discharged to the rehabilitation facility in good condition. condition on discharge: good. discharge destination: facility. discharge diagnosis: 1. pancreatitis, status post exploratory laparotomy with lysis of adhesions. 2. duodenal perforation, status post exploratory laparotomy, oversewing of the duodenal perforation and jejunostomy tube placement. 3. intra-abdominal abscesses, status post drainage. 4. urinary tract infection (yeast). 5. hypertension. 6. gastroesophageal reflux disease. discharge medications: 1. gentamicin 60 mg intravenously q. 8 hours 2. ceftazidime 2 gm intravenously q. 8 hours 3. fluconazole 400 mg intravenously q. day 4. metoprolol 50 mg b.i.d. through jejunostomy tube 5. insulin regular sliding scale 6. tylenol 325 mg to 650 mg via jejunostomy tube prn 7. reglan 10 mg q.i.d. via jejunostomy tube 8. miconazole powder 2% b.i.d. 9. artificial tears one to two drops prn 10. albuterol 4 puffs inhaler q. 6 hours prn 11. lansoprazole oral solution 30 mg via jejunostomy tube 12. heparin 500 units subcutaneously q. 12 hours 13. tube feeds, specifically promote with fiber cycled over night. discharge instructions: 1. the patient is to follow up with dr. , her surgeon within the next week to two weeks after discharge. 2. the patient is to follow up with her primary care physician within the next two weeks. , m.d. dictated by: medquist36 d: 12:23 t: 08:13 job#: procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances percutaneous abdominal drainage exploratory laparotomy insertion of other (naso-)gastric tube other lysis of peritoneal adhesions other laparotomy other laparotomy other repair of intestine other miscellaneous procedures diagnoses: acidosis unspecified pleural effusion candidiasis of other urogenital sites perforation of intestine peritoneal adhesions (postoperative) (postinfection) other and unspecified alcohol dependence, unspecified acute pancreatitis alcohol withdrawal 

Answer: The patient is high likely exposed to