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: hypotension, purulent feeding tube drainage major surgical or invasive procedure: rij central line history of present illness: mr. is a 40 year-old male with hx of metastatic gastric cancer s/p multiple abdominal surgeries s/p intrabdominal chemo/xrt who presented to the ed yesterday after his g-tube fell out and was admitted to the due to sepsis. . per her wife, he was fine until yesterday when she noticed pus around the g-tube. she cleaned it and the button came out (however the tube was in). he was eating soup and liquids and food was coming out around the tube. he took a nap, then woke up and the it was out on the floor with pus coming from the site. per omr records the patient had a fever to 101.4 the day prior to admission. . he had a recent admission from /10 for arf, hyperkalemia, and small bowel versus gastric outlet obstruction. during this admission a peg tube was placed for decompression of his stomach and a port-a-cath was placed for initiation of tpn. he was also started on epirubicin, cisplatin, and fluorouracil on . he was discharged on on continuous fluorouracil. he then returned to the hospital from /10 due to abdominal pain and nausea during which his chemo was stopped. during this admission, he was made dnr/dni and was discharged home with hospice care. . his wife brought him to the where initial vs: t 100, bp 114/74, hr 140, rr18, 97%. he subsequently dropped his blood pressure to 70/64 with maps in the 40's. labs were notable for a wbc of 24 and a mild transaminitis. on exam he was reported to have a tender abdomen and pus was noted to come from the g-tube site. a right ij was placed and he received 8 l of ns and was started on levophed. he also was given 2 gm cefepime iv, 1 gm vanc iv, and 1 mg ativan iv. he denied pain on presentation and was on his home dilaudid pca pump. code status was addressed and reportedly he was made full code again. . currently he only groans to most questions and requests to be left alone so he can sleep. he denied pain. . review of systems: unable to obtain. past medical history: past oncologic history: gastric cancer, metastatic other past medical history: h/o cre bsi chronic pain past surgical history: s/p subtotal gastrectomy/billroth ii anastomosis s/p omentectomy s/p radical ln dissection l gastric region s/p percutaneous cholecystostomy tube s/p ccy s/p roux-en-y hepaticojejunostomy to right posterior hepatic duct and confluence of right anterior and left hepatic ducts over two 5-french feeding tubes () s/p ex-lap/repair colon enterotomy/peritoneal bx on for roux limb obstruction social history: lives in with his wife. a son from a prior marriage. unemployed chef. tobacco: denies. etoh: denies. illicits: denies family history: maternal grandmother with "stomach cancer" father with diabetes physical exam: vitals: t: 98.6 bp: 115/58 p: 141 r: 21 o2: 92 % on 2 l nc. general: middle-aged male lying in bed. will mostly groan to questions or examination and will not answer specific questions other then his son's name. does not consistently follow commands and asks to be left alone to sleep. heent: would not open his eyes or mouth. neck: right ij present lungs: breathing comfortably, clear anteriorly. cv: regular and tachycardic. no mrg. abdomen: g-tube in place in the luq with slight white discharge around it. two drains present in his ruq draining dark brown material. abdomen is firm and appears tender to palpation. no rebound detected when the bed is shaken. ext: warm, no clubbing, cyanosis or edema pertinent results: admission labs: 10:30pm pt-15.6* ptt-32.9 inr(pt)-1.4* 10:30pm plt count-662* 10:30pm neuts-84.5* lymphs-9.5* monos-5.0 eos-0.5 basos-0.5 10:30pm wbc-24.0*# rbc-2.89* hgb-7.6* hct-24.5* mcv-85 mch-26.4* mchc-31.2 rdw-17.6* 10:30pm albumin-2.8* calcium-8.8 phosphate-3.7 magnesium-1.9 10:30pm lipase-7 10:30pm alt(sgpt)-46* ast(sgot)-54* alk phos-367* amylase-10 tot bili-2.5* 10:30pm estgfr-using this 10:30pm glucose-88 urea n-17 creat-0.5 sodium-140 potassium-3.7 chloride-102 total co2-30 anion gap-12 10:35pm lactate-0.8 10:35pm comments-green 12:35am urine granular-0-2 12:35am urine rbc-0-2 wbc-0-2 bacteria-mod yeast-none epi-0-2 . other labs: 10:30pm blood alt-46* ast-54* alkphos-367* amylase-10 totbili-2.5* 07:23am blood alt-38 ast-42* ld(ldh)-179 alkphos-314* totbili-2.4* 03:31am blood alt-32 ast-36 alkphos-277* totbili-2.0* 06:00am blood albumin-2.3* 06:00am blood triglyc-76 . discharge labs: 06:01am blood wbc-13.9* rbc-2.58* hgb-7.4* hct-23.2* mcv-90 mch-28.6 mchc-31.8 rdw-19.7* plt ct-407 06:01am blood neuts-84* bands-0 lymphs-3* monos-11 eos-2 baso-0 atyps-0 metas-0 myelos-0 06:01am blood hypochr-3+ anisocy-1+ poiklo-occasional macrocy-occasional microcy-1+ polychr-1+ target-2+ stipple-1+ pappenh-occasional envelop-1+ 06:01am blood pt-16.6* ptt-33.5 inr(pt)-1.5* 06:01am blood glucose-112* urean-15 creat-0.5 na-133 k-4.1 cl-100 hco3-28 angap-9 06:01am blood calcium-8.2* phos-3.9 mg-1.9 . microbiology blood cultures: negative biliary drain site swab: mixed bacterial types (>=3), abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. bile culture: 1+ polys, 4+ gpcs in pairs and chains, 4+ gnrs, 4+ gprs on gram stain, mixed bacterial flora in culture bile culture: 4+ gnrs on gram stain, mixed bacterial flora in culture urine culture: negative blood culture: lactobacillus blood cultures: negative blood cultures: negative blood cultures: pending, no growth to date at time of discharge urine culture: negative . imaging: cxr: 1. left basilar atelectasis and effusion. infection cannot be excluded. 2. stable positioning to port-a-cath catheter. biliary drains in place. . : ct abdomen/pelvis: 1. new rim enhancing intra-abdominopelvic fluid collection, likely infected. 2. enhancing dilated biliary ducts around anterior internal-external biliary drain, concerning for cholangitis. 3. segment viii lesion, which may be an abscess or metastasis. 4. fluid-filled distended duodenum, which may be partially obstructed. edematous loops of bowel in the mid abdomen. complex post-surgical anatomy, full evaluation limited by lack of oral contrast. 5. foley in the stomach which is markedly thickened suggesting possible gastric cancer growth. 6. bilateral effusions and atelectasis much greater on the left. infection of the lung bases cannot be excluded. . cxr: there is a right ij line with tip in the svc. right hemidiaphragm is mildly elevated. drainage catheter is seen overlying the right abdomen. there is a small left pleural effusion that is increased compared to prior. brief hospital course: 40 year-old male with hx of metastatic gastric cancer, s/p multiple abdominal surgeries, and s/p intra-abdominal chemo/xrt who presented to the ed after his g-tube fell out and was admitted with sepsis, likely from intra-abdominal source. . # hypotension/sepsis: the patient presented to the ed with frank pus extravastating from his g-tube site and hypotension. ct abd/pelvis revealed an intra-abdominal rim-enhancing fluid collection. based upon abdominal imaging and clinical picture, he was diagnosed with sepsis. early goal therapy was initiated. he was covered with broad spectrum antibiotics (vanc, cefepime, flagyl) in addition to anti-fungal therapy with micafungin since he had been receiving tpn. he required pressure support with leveophed, which was eventually weaned. ct body and ir were consulted for potential drain(s) replacement, and a new g-tube. he would have required multiple procedures and general anesthesia. after a goals of care discussion with his wife, he was made dnr/dni with treatment goals for symptom and sepsis management. he was transferred to the floor in stable condition. blood culture from was positive for lactobacillus. surveillance blood cultures drawn after that time were negative. the patient was closely followed by the infectious disease consult team, and antibiotic/antifungal coverage was gradually narrowed. he remained hemodynamically stable, but did have several spikes in temperature to as high as 101.5 while on the floor. the most likely source for his fever was felt to be persistent intra-abdominal infection, with limited antibiotic penetrance into abdominal fluid collection. the patient again declined any surgical or ir-guided drainage of the fluid collection, as his goal was to be discharged home with hospice care. he was discharged home on ceftriaxone, and per id he will need to be on this antibiotic indefinitely. he was afebrile at the time of discharge, hemodynamically stable, and feeling well. he was instructed to take acetaminophen as needed for pain/fever, but advised not to take more than 4g of acetaminophen per day. . #. metastatic gastric cancer: the patient had been on hospice previously, however per oncology and surgery providers who know him, consistency in goals of care has been difficult. at time of discharge, the patient was again to receive hospice care at home. he is not currently receiving chemotherapy. he will continue to use a dilaudid pca for pain control, and will receive ivfs through his portacath. he will no longer receive tpn at home, but is able to tolerate a clear liquid diet. he will continue to take prochlorperazine as needed for nausea. . # anemia: patient's baseline hct prior to admission was in mid 20's. there was no evidence of acute bleeding during his hospital course. he was transfused one unit prbcs while in the icu. his hct remained stable, around 22-23, while he was on the medical oncology floor. he had some episodes of tachycardia, but otherwise remained hemodynamically stable. medications on admission: home medications: (per omr) -dilaudid pca through intravenous route. -tpn: 2000ml/day, amino acid: 100g/day, dextrose 350g/day, fat 40g/day nacl: 110, naac: 0, napo4: 45, kcl: 75, kac: 0, kpo4: 0, mgso4: 17, cagluc: 10 -ursodiol 300 mg po bid -docusate sodium 100 mg po bid -senna 8.6 mg 2 tabs po daily prn constipation -ferrous sulfate 300 mg po daily -zofran 4 mg 1-2 tablets po q8hrs prn nausea -prochlorperazine maleate 10 mg po q6hrs prn nausea -imodium a-d 2 mg po q4hrs prn diarrhea -ativan 0.5 mg 1-2 tabs po q4hrs prn nausea/anxiety -morphine concentrate 5 mg po q4hrs prn pain/sob discharge medications: 1. hydromorphone 10 mg/ml solution sig: four (4) mg/hr injection asdir (as directed): hydromorphone (dilaudid) 2 mg ivpca asdir lockout interval: 10 minutes basal rate: 4 mg(s)/hour 1-hr max limit: 16 mg(s) this can be uptitrated as needed by hospice nurse. :*4 cassettes* refills:*2* 2. ceftriaxone 1 gram recon soln sig: one (1) gram intravenous once a day. :*30 doses* refills:*2* 3. prochlorperazine edisylate 5 mg/ml solution sig: ten (10) mg injection q6h (every 6 hours) as needed for nausea. :*30 doses* refills:*0* 4. ivfs d5 1/2 ns at 75 cc/hour, to be adjusted by hospice nurses based in symptoms and i/os 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. discharge disposition: home with service facility: hospice and palliative care discharge diagnosis: metastatic gastric cancer sepsis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with an infection in your blood, which was caused by an infected fluid collection in your abdomen. you were treated in with iv fluids, medications to help your blood pressure, and antibiotics. you were initially treated in the icu, then transferred to the general oncology floor when your blood pressures were stable. you were see by the infectious disease team, who made recommendations about what antibiotics you should continue taking. after you leave the hospital, you will only need to continue taking ceftriaxone. if you continue to have fevers, you may take tylenol for your symptoms. it is important that you do not take more than 4 grams of tylenol per day. . you received nutrition through your portacath line while you were here. at home you will continue to receive iv fluids though your port to keep you hydrated. you may continue to eat/drink clear liquids and foods such as broth and jello. . your pain was well-controlled with a dilaudid pca (the machine that delivers the pain medication). you will be able to use this machine to continue managing your pain at home. the hospice nurses will be able to adjust your dosing if you develop more pain. . you will be discharged to your home, with hospice services in place. you will continue to receive one antibiotic (ceftriaxone), iv fluids, and pain medication. followup instructions: you will have hospice care at home. you may follow-up with your primary care doctor, dr. . the clinic number is . you should also follow-up with your oncologist, dr. . the clinic number is . md procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnoses: malignant neoplasm of liver, secondary severe sepsis pulmonary collapse septic shock other malignant neoplasm without specification of site infection and inflammatory reaction due to other internal prosthetic device, implant, and graft anemia in neoplastic disease secondary malignant neoplasm of retroperitoneum and peritoneum other gastrostomy complications surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation malignant neoplasm of stomach, unspecified site 

Answer: The patient is high likely exposed to