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: levofloxacin / metronidazole attending: chief complaint: ruq pain and fever major surgical or invasive procedure: picc line placement history of present illness: mr. is a 60 year-old man with advanced als, chronic trach/mechanical ventilation, peg, h/o dvt/pe on warfarin who presents from home with ruq pain and fever. wife reports that patient began c/o ruq abdominal pain 1 week ago and became febrile to at home 2 days ago now to 101f. wife also states that he has been having more frequent bms as well; stools are liquid, which is his baseline. of note, patient was recently admitted in for cholangitis and underwent ercp and stone removal durring that admission. patient was discharged home on iv zosyn for 2 additional days, which patient completed two weeks ago. initaial vitals in the ed were 99.0 95 118/68 12 100% ventilated. exam was notable for ruq tenderness, bs+ and peg tube in place. labs in the ed were notable for wbc 13.6 80%n, hct 33.2, alt 56, ast 45, ap 412, tbili 1.3, alb 3.5, inr 1.6, ua wnl. cxr showed persistance of left lung base consolidation and interval improvement in right pleural effusion. ruq us showed cbd stent in place with improved ductal dilitation. ct a/p showed multiple hypoattenuating liver lesions concerning for developing abscess. both cxr and ct chest also suggest possible lll pna. transplant surgery was consulted for liver findings and advised admission for iv antibiotics. patient received 4.5g iv zosyn and was admitted to micu for further monitoring. vital signs on transfer were 97.7 87 110/60 16 99% on ventilator. on arrival to the micu, the patient appears comfortable and is able to communicate using eyebrow movements and board drawn on dry erase board. past medical history: -als bed-ridden for 5 years w/ chronic trach/mechanical ventilation -chronic peg -dvt/pe on warfrain -hypothryoidism social history: lives with wife. is bed-ridden x 2 years due to als. currently communicates by raising his eye brows, up is yes, no movement is no. - tobacco: denies - alcohol: denies - illicits: denies family history: father had unknown type of cancer physical exam: admission exam general: alert, no acute distress, non verbal, communicates with eye brow raising, rising eye brows indicates yes, no response is no movement of eyes. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not able to assess, trach in place lungs: clear to auscultation bilaterally on ant exam, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: ruq tenderness without guarding or rebound, non-distended, hypoactive bs, no organomegaly gu:foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam general: alert, no acute distress, non verbal, communicates with eye brow raising, rising eye brows indicates yes, no response is no movement of eyes. today indicates that he is having difficulty breathing secondary to secretions heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not able to assess, trach in place lungs: clear to auscultation bilaterally on ant exam, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: no ruq ttp, no rebound, non-distended, normal bs, no organomegaly gu:foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neurologic: raises eye brows to communicate pertinent results: admission labs: 04:45pm blood wbc-13.6*# rbc-4.04* hgb-10.7* hct-33.2* mcv-82 mch-26.6* mchc-32.4 rdw-17.1* plt ct-453* 04:45pm blood neuts-80.0* lymphs-14.2* monos-4.5 eos-1.1 baso-0.4 04:45pm blood pt-17.5* ptt-34.0 inr(pt)-1.6* 04:45pm blood alt-56* ast-45* alkphos-412* totbili-1.3 04:45pm blood albumin-3.5 03:57pm blood glucose-92 lactate-1.4 na-134 k-4.0 cl-104 calhco3-21 03:57pm blood freeca-1.00* . discharge labs 03:19am blood wbc-9.8 rbc-3.46* hgb-9.4* hct-28.8* mcv-83 mch-27.0 mchc-32.5 rdw-16.9* plt ct-412 03:19am blood pt-20.1* ptt-32.8 inr(pt)-1.9* 03:19am blood glucose-123* urean-5* creat-0.1* na-138 k-3.7 cl-109* hco3-20* angap-13 03:19am blood calcium-8.3* phos-2.4* mg-2.1 . urine 04:45pm urine color-yellow appear-clear sp -1.008 04:45pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-8.5* leuks-neg 04:45pm urine rbc-0 wbc-1 bacteri-none yeast-none epi-<1 transe-<1 . micro: urine cx: no growth blood cx - no growth to date (final pending at time of discharge) sputum cx: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (preliminary): rare growth commensal respiratory flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. pseudomonas aeruginosa. moderate growth. piperacillin/tazobactam sensitivity testing performed by . pseudomonas aeruginosa. moderate growth. second morphology. gram negative rod #3. sparse growth. gram negative rod #4. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 32 r ceftazidime----------- =>64 r ciprofloxacin---------<=0.25 s gentamicin------------ 4 s meropenem-------------<=0.25 s piperacillin/tazo----- r tobramycin------------ <=1 s . studies: cxr : comparison to exam, moderate left pleural effusion is unchanged. persistent left lung base consolidation may represent atelectasis or infection in appropriate clinical setting. . ruq ultrasound : 1. common bile duct stent with decompression of the previously seen biliary ductal dilatation. 2. decompressed, sludge and stone-filled gallbladder, without evidence of cholecystitis. . ct abdomen and pelvis 1. moderate left pleural effusion with enhancement of the adjacent pleural raising concern for empyema. small basilar consolidations, may represent atelectasis, aspiration or infection in the appropriate clinical setting. 2. heterogeneous liver enhancement with numerous focal hypodensities, some of which appear simple in nature however there are several ill defined hypodensities with surrounding hyperenhancing parenchyma. in the setting of recently reported ascending cholangitis, hepatic abscesses would be of concern. obtaining recent outside ct to evaluate for interval change may help further characterize. 3. no evidence of acute cholecystitis. sludge and numerous tiny stones. gallbladder stones are better seen on the ultrasound exam of the same date. 4. l1, l3, and l5 compression deformities of indeterminate chronicity. . cxr in comparison with the study of , there are again areas of increased opacification at the bases with poor definition of the hemidiaphragms, more prominent on the left. this is consistent with layering pleural effusion and underlying atelectasis. in the appropriate clinical setting, the possibility of supervening pneumonia would have to be considered. tracheostomy tube remains in place and there is no evidence of vascular congestion. . cxr (prelim read) malpositioned right picc catheter in the lateral chest wall, recommend repositioning. stable large bilateral pleural effusions. . brief hospital course: primary reason for hosptiatlization: patient is a 60yo male with advanced als, chronic trach/mechanical ventilation/peg, dvt/pe on warfarin admitted with ruq pain, fever and suggestion of hepatic abscess on ct a/p. 1. hepatic abscess - patient presented with fever and ruq pain with multiple hepatic hypodensities concerning for developing hepatic abscess in the setting of recent cholangitis. patient also had leukocytosis to 13.6 with slight left shift on presentation. previously placed cbd stent remained in-place with improved ductal dilitation and decompressed gallbladder. transplant surgery evaluated patient in the ed and advised conservative management with iv zosyn. bilirubin has appropriately downtrended. he was restarted on zosyn and a picc line was placed by ir. patient clinically improved. he was discharged with plans to complete a 6 week course of zosyn. he will have vna with weekly labs (cbc and chem7) which will be faxed to his pcp. # lll consolidation - wife does not report increase volume or change in the nature of the patients secretions. additionally, cxr finding appear consistent with that from suggesting no new process. nontheless, the patient has been chronically trach/vent dependent for 5 years and would therefore be prone to deveoping ventilator associated pna. sputum culture grew pseudomonas in a polymicrobial culture, without compelling evidence for a dominant strain or active infection. given that patient looked well from a respiratory standpoint and maintained on his home settings with no change in secretions or oxygen saturations, it was felt that this growth represented a colonization rather than a true infection and he was not provided antibiotics for this culture result. # clostridium difficile infection - patient was noted to have diarrhea during admission. cdiff toxin returned positive. given allergy to flagyl, patient was started on po vancomycin. he was discharged with plans to continue vancomycin for 2 weeks after zosyn is discontinued (likely 8 weeks). # h/o pe - patient is on home warfarin for history of pe. recent discharge instructions noted lovenox bridge for warfarin. admission inr is 1.6, therefore patient was continued on lovenox bridge while in house. his lovenox was discontinued when inr became therapeutic. he was discharged on home warfarin dose. # advanced als - patient has quite advanced als and is bed-bound and trach/vent depended with communication limited to eyebrow movement. however, patient appears to readily be able to communicate with his wife, who instructed nurses and rt on the use of the dry-erase letter board. he was continued on combivent, omeprazole, rilutek, scopolamine, glycopyrrolate and miralax. # nutrition: continued tube feeds transitional issues: # communication: patient and his wife who is his pcp # code: full confirmed with pt # emergency contact- who is hcp h , c , w # patient will need to continue on zosyn for 6 weeks from discharge # patient will have weekly chem 7 and cbcs drawn and sent to pcp # patient will need to be treated with oral vancomycin for 8 weeks (2 weeks after last day of zosyn) # patients inr will need to be followed medications on admission: combivent 18-103 4 puffs q3h ferrous sulfate 300mg liquid omeprazole 20 mg liquid daily rilutek 50 mg enoxaparin 80 mg q12 until inr >2.0 scopolamine base 1.5 mg patch q72 hr glycopyrrolate 2 mg q6h polyethylene glycol 17 gram qod warfarin 2 mg mo,fr and 3 mg ,tu,we,th,sa discharge disposition: home with service facility: home health services discharge diagnosis: primary: - liver abscess - c. difficile colitis secondary: - amyotrophic lateral sclerosis - history of pulmonary embolism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to for liver abscess. while in the hospital, you were started on antibiotics to treat for the abscess. it was too small to be drained. therefore, you will need to have zosyn (an antibiotics) for at least 6 weeks. you had a picc line placed so that you could get antibiotics at home. you also developed c. difficile diarrhea after started on the antibiotics to treat for the liver abscess. therefore, you were started on another antibiotics called vancomycin. this will treat the c. difficile diarrhea. you will need to be on this while you are on zosyn for the liver abscess, in addition, you will need to take this for 2 more weeks after you complete the zosyn course. it will be extremely important for you to follow up with your primary care physician. please note the following changes in your medications. please start taking: - vancomycin oral, continue while on zosyn and continue for another 2 weeks after you finish zosyn. - zosyn iv, for at least 6 weeks . please stop taking: - lovenox. you do not need bridging because your clot occured many years ago. followup instructions: pcp : tuesday, at 11:15am with: bliss,np,who works closely with your pcp, . , location: house address: , , phone: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances central venous catheter placement with guidance diagnoses: acidosis esophageal reflux hyposmolality and/or hyponatremia unspecified acquired hypothyroidism hypopotassemia amyotrophic lateral sclerosis intestinal infection due to clostridium difficile abscess of liver long-term (current) use of anticoagulants personal history of venous thrombosis and embolism gastrostomy status chronic respiratory failure tracheostomy status dependence on respirator, status personal history of pulmonary embolism 

Answer: The patient is high likely exposed to