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: iv dye, iodine containing contrast media attending: chief complaint: abdominal pain with free on abdominal scan major surgical or invasive procedure: right hemicolectomy, mucous fistula, ileostomy. history of present illness: 67f with esrd sle maintained on chronic prednisone recently started transferred from for free air on ct abd/pelvis. details of her hospital course are limited and the patient is not a reliable historian. apparently the patient underwent a c-scope and polypectomy 4 weeks ago. patient does not recall any complications afterwards but 3 weeks ago, she underwent an ex-lap for signs of "bowel perforation" (it appears that the patient had signs of sbo, underwent a ct scan showing perforation). the laparotomy was negative for a source. she was in the hospital for almost 2 weeks and was discharged on . she returned back to on for left thigh pain and was found to have a hematoma supratherapeutic inr (5.6). of note she had a right rectus abdominal wall hematoma last admission. these bleeds required reversal of coumadin and multiple blood transufsions. on a lle us was performed showing no evidence of dvt in the fem, and calf veins. since being in the hospital, the patient has had a ftt picture. she has enterococcus and utis and was started on vanco and gent. it was mentioned that she would start amphotericin but per her omr, this was not given. she was stared on hd last friday for hyperkalemia. most recently in the last 2-3 days, she has been c/o increasing abdominal pressure/pain, nausea, and poor po intake. she is unable to tolerate clears very well nausea. she states she had a bm in the am but since then has not passed flatus. per transfer summary, after this bm she had signficant abdominal pain with peritoneal signs. a ct scan was performed showing free air. access: right tunneled hd line, l ij triple lumen past medical history: 1. cardiac risk factors: -diabetes, +dyslipidemia, +hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: cardiac cath at in : des to rca -pacing/icd: none 3. other past medical history: severe aortic stenosis systemic lupus erythematosis tia pvd (65% stenosis in carotid arteries) hld l vocal chord dysfunction gerd copd mvr (mild) dvt (s/p anticoagulation with coumadin discontinued approximately three weeks ago in ) carpal tunnel syndrome ckd baseline cre 1.2->1.7 retrosternal calcification (chronic) social history: married. retired hairdresser. lives in . -tobacco history: 20 ppy smoking hx, quit 27 years ago -etoh: etoh drinks weekly -illicit drugs: denies family history: father died at 75 from cad. aunt died of mi at 49. sister with a pacemaker. physical exam: admission pe: 99.5 78 161/733 18 98ra gen: supine in bed, appears comfortable, answers appropriately, a+ox3 cv: rrr, soft systolic murmur heard resp: ctab abd: ttp with rebound tenderness in ruq and rlq, no hsm, no ttp on left side, previous ex-lap midline scar healing dre: not performed given pain during examination ext: left le swollen hematoma, ttp posterior thigh, 2+ pitting le edema pulses: 2+ radial b/l, right fem 1+, left fem 2+, faintly palp dp pulses b/l pertinent results: 10:15pm blood wbc-10.7# rbc-3.83*# hgb-12.0 hct-36.3# mcv-95 mch-31.4 mchc-33.2 rdw-18.0* plt ct-148* 05:13am blood wbc-12.4* rbc-3.58* hgb-10.9* hct-34.4* mcv-96 mch-30.5 mchc-31.7 rdw-17.9* plt ct-130* 05:05am blood wbc-13.4* rbc-2.79* hgb-8.5* hct-27.3* mcv-98 mch-30.5 mchc-31.2 rdw-17.8* plt ct-124* 07:41am blood wbc-9.2 rbc-2.68* hgb-7.8* hct-25.8* mcv-96 mch-29.2 mchc-30.3* rdw-16.3* plt ct-194 05:40am blood pt-18.7* ptt-37.3* inr(pt)-1.8* 06:31am blood pt-23.5* ptt-42.7* inr(pt)-2.2* 07:41am blood pt-24.9* ptt-43.3* inr(pt)-2.4* 10:15pm blood glucose-65* urean-25* creat-2.4* na-134 k-4.0 cl-98 hco3-30 angap-10 03:35am blood glucose-69* urean-56* creat-4.2* na-132* k-4.6 cl-100 hco3-25 angap-12 07:41am blood glucose-82 urean-26* creat-2.6* na-135 k-4.1 cl-99 hco3-29 angap-11 05:13am blood alt-13 ast-25 alkphos-161* totbili-1.0 05:05am blood alt-11 ast-21 alkphos-99 totbili-1.0 07:41am blood calcium-7.4* phos-3.2 mg-1.7 05:12am blood c3-80* c4-24 11:33am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative igm hbc-negative igm hav-negative 11:33am blood hcv ab-negative 5:32 pm swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): enterococcus sp.. sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | vancomycin------------ >256 r blood cultures: pending 1:30 am swab peritoneal fluid. a swab is not the optimal specimen collection to evaluate body fluids. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. brief hospital course: 67f with sle maintained on chronic steroids, esrd recently on hd here with free air seen on ct scan. rebound tenderness was appreciated on pe. she was taken to the or by dr. w. after cardiology was consulted and cleared her for or. she underwent right hemicolectomy, mucous fistula, ileostomy for microperforation of the distal sigmoid colon and stercoral perforation of the right colon(hepatic flexure). postop, she did well from gi standpoint. ileostomy was working. diet was slowly advanced over several days and tolerated. mucous fistula appeared edematous and had a small amount of clear fluid draining. an ostomy pouch was applied. please refer to enterostomal note. abdominal incision had staples. abdomen was distended. an ultra sound was done to assess for ascites given h/o cirrhosis. a small loculated fluid pocket with septations in the right lower quadrant containing multiple bowel loops was noted. this was not adequate for paracentesis. incision had a small amount of clear fluid drainage. dry gauze dressing was changed twice on . drainage was scant on . she was also noted to have a stage 2 decubitus on her sacrum which was covered by mepilex and changed every 3 days. she received a total of 4 days of vanco and zosyn for coverage for gi organisms.blood cultures remained negative to date. blood cultures were un finalized at time of discharge to rehab. pain was initially managed with iv dilaudid. this was switched to po dilaudid once diet was tolerated. she averaged 4mg po approximately 3 times per day for abdominal incision/back and leg pain. hct decreased over over the initial postop days then was stable at 25-26. renal was consulted for acute on chronic renal failure. urine output decreased with increase in creatinine. acute kidney injury was secondary to hypotension/blood loss. she was initially managed with lasix. however, she was very edematous and had very low urine output. hemodialysis was performed on removing 1.95kg. dialysis was repeated on with 3 liters removed and again on with 1.5 liters removed. she tolerated the treatments well with sbp in the 140s and heart rates in 88-95 range. it was felt that her would resolve and that she would not require chronic dialysis. the plan was for her to be assessed on a daily basis. urine output for 24 hours was up to 300ml/day on . a right tunnelled line was present (previously placed at osh). pt was consulted recommended rehab for strengthening. two person assist with rolling walker was necessary. mobility improved over subsequent days. she required dilaudid coumadin for h/o lupus anticoagulant was resumed on at 3mg. inr was 2.4 on and coumadin was decreased to 2.5mg. prednisone continued for sle management. the plan was for her to continue on dialysis at least 2-3 times a week until renal function improved. of note, vein mapping was done while hospitalized at . she was accepted at n.e. in and will transfer there today. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient medications brought in by husband. 1. ascorbic acid 1000 mg po daily 2. acetaminophen 500 mg po q6h:prn pain 3. ferrous sulfate 325 mg po daily 4. docusate sodium 100 mg po bid 5. pravastatin 40 mg po daily 6. amlodipine 10 mg po daily 7. cyclobenzaprine 10 mg po tid:prn back pain 8. warfarin 5 mg po daily16 as directed for inr 9. calcium carbonate 500 mg po daily 10. furosemide 40 mg po daily 11. alprazolam 0.5 mg po qhs:prn insom 12. sodium bicarbonate 650 mg po qid 13. oxycodone (immediate release) 5 mg po q6h:prn pain 14. hydralazine 50 mg po q6h 15. omeprazole 40 mg po daily 16. prednisone 5 mg po daily 17. warfarin 1 mg po daily16 as directed for inr 18. calcium acetate 667 mg po tid w/meals 19. vitamin d 1000 unit po daily 20. aspirin 81 mg po daily 21. cyanocobalamin 1000 mcg im/sc q month 22. hydrochlorothiazide 12.5 mg po daily 23. chlorzoxazone *nf* 500 mg oral tid back pain 24. carvedilol 25 mg po bid 25. deep sea nasal *nf* (sodium chloride) 0.65 % nu q 6 hours 26. fluticasone *nf* 50 mcg/actuation nu 2 sprays discharge medications: 1. acetaminophen 500 mg po q6h:prn pain 2. alprazolam 0.5 mg po qhs:prn insom 3. amlodipine 10 mg po daily 4. hydralazine 50 mg po q8h hold for sbp < 100 5. carvedilol 25 mg po bid 6. omeprazole 40 mg po daily 7. prednisone 5 mg po daily 8. warfarin 2.5 mg po daily16 9. tiotropium bromide 1 cap ih daily 10. fluticasone *nf* 50 mcg/actuation nu 2 sprays 11. nephrocaps 1 cap po daily 12. ferrous sulfate 325 mg po daily 13. aspirin 81 mg po daily 14. vitamin d 1000 unit po daily 15. pravastatin 40 mg po daily 16. cyanocobalamin 1000 mcg im/sc q month 17. fluticasone propionate nasal 1 spry nu daily 18. fluticasone-salmeterol diskus (250/50) 1 inh ih 19. hydromorphone (dilaudid) 4 mg po q6h:prn pain 20. calcium carbonate 500 mg po daily discharge disposition: extended care facility: - discharge diagnosis: -microperforation of the distal sigmoid colon and stercoral perforation of the right colon(hepatic flexure). -acute on crf -sle discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: please call dr. office if you have any of the following: temperature of 101 or greater, chills, nausea, vomiting, increased abdominal distension, ileostomy output stops or stool output is greater than 2 liters per day, incision redness/bleeding/drainage, dialysis access malfunctions. change ileostomy pouch every 3 days and prn hemodialysis 3x per week weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: provider: , md, phd: date/time: 11:40 md, procedure: hemodialysis open and other right hemicolectomy other permanent ileostomy diagnoses: systemic lupus erythematosus hyperpotassemia anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux acute kidney failure with lesion of tubular necrosis long-term (current) use of steroids chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified hyperlipidemia heart valve replaced by other means chronic kidney disease, stage iii (moderate) long-term (current) use of anticoagulants accidental cut, puncture, perforation or hemorrhage during other specified medical care pressure ulcer, lower back personal history of venous thrombosis and embolism other specified peripheral vascular diseases primary hypercoagulable state hemorrhage of gastrointestinal tract, unspecified pressure ulcer, stage ii 

Answer: The patient is high likely exposed to