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: failure to thrive major surgical or invasive procedure: tracheostomy peg placement ivc filter placement history of present illness: initial admission to surgery: 75ym who underwent c-scope on . he returned that night after dinner with abdominal pain. found to have pneumoperitoneum. initially treated conservatively but failed the following morning, taken to the or for exlap. transverse colon 1 cm perforation found which was repaired with a stapled primary repair as well as diverting ileostomy. postop had difficult course including: paroxysmal afib, malnutrition on tpn, delirium, and repeated mucous plugging requiring reintubation and bronchoscopy. he was tranferred here per the family request. . on transfer to floor: 75 yo with pmh of cad, infrarenal aaa, htn, hemochromatosis, dementia/delerium was transferred from osh on after he had a complicated hospital course for iatrogenic colonic perforation colonoscopy, s/p primary repair with diverting ileostomy. he had multiple organisms grew from blood culture and sputum culture (e. coli, pseudomonas, coag neg staph, alpha srep, etc.) for which he has been treated with multiple abx (cefepime, vancomycin, cipro, levofloxacin). pt is s/p trach on , peg and ivc placement on . no significant hemodynamic instability during precedures, but his sbp became lower over the past 2-3 days (120-130 -> 90-100's). found to have new developed rll pna yesterday. his creatinine was elevated to 2.2 on admission , improved to 1.4. however, it started to elevate again since , up to 3.0 today. uop started decreasing at the same time to 400-500ml/day. large amount of ileostomy output 1-2l/day. no contrast or nsaids exposure. as per his wife, his had normal renal funciton before his complicated medical events. on transfer, he continued to have persistent altered mental status with minimal responsiveness, per wife this has been ongoing since outside hospital. thought to be combination of anoxic brain injury / toxic metabolic encephalopathy in the setting of normal lp, ct scan and eeg, with concomitant uremia, hypoactive delirium, and infection exacerbating. past medical history: pmh: cva , cad with stents, mi x3, htn, hemochromatosis, aaa 3.3cm psh: pacemaker, repair of transverse colon perforation social history: sh: originally from , moved to back in then moved up to a few years ago. retired factory manager. no tobacco or drugs. drinks 1 glass of red wine nightly. family history: non-contributory. physical exam: on admission to surgery: pe: gen: intubated, sedated but arousable heent: anicteric cv: rrr pulm: cta b/l abd: soft, distended, nontender, ileostomy functioning with small amount of gas and green fluid in the bag. incision c/d/i without drainage. ext: 1+ edema, palp pulses . on transfer to medicine: gen: does not open eyes, does not track, blinks to threat, in no apparent distress heent: trach in place, mild secretions cvs: rrr, normal s1/s2 lungs: bibasilar rhonchi, r>l (anteriorly) abd: soft, peg tube and ileostomy bag in place, non-distended, peg tube output appears almost black ext: no edema, cyanosis or clubbing neuro: non-verbal, does not follow commands or respond to verbal stimuli; localizes to painful stimuli, no posturing or increased tone, perrla pertinent results: 11:14pm cerebrospinal fluid (csf) protein-27 glucose-67 11:14pm cerebrospinal fluid (csf) wbc-0 rbc-1* polys-0 lymphs-100 monos-0 02:40am type-art po2-124* pco2-34* ph-7.36 total co2-20* base xs--5 02:40am lactate-1.3 01:22am urine blood-lg nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-5.0 leuk-mod 01:21am glucose-98 urea n-55* creat-2.2* sodium-141 potassium-3.8 chloride-112* total co2-19* anion gap-14 01:21am alt(sgpt)-40 ast(sgot)-42* ld(ldh)-208 alk phos-50 tot bili-2.4* 01:21am albumin-2.0* calcium-9.6 phosphate-5.1* magnesium-2.1 iron-8* 01:21am wbc-14.0*# rbc-2.92*# hgb-9.5*# hct-27.4*# mcv-94# mch-32.5* mchc-34.7 rdw-16.9* 01:21am neuts-76* bands-4 lymphs-8* monos-8 eos-2 basos-0 atyps-0 metas-2* myelos-0 01:21am hypochrom-1+ anisocyt-normal poikilocy-occasional macrocyt-normal microcyt-occasional polychrom-normal 01:21am pt-20.6* ptt-30.1 inr(pt)-1.9* 01:21am pt-20.6* ptt-30.1 inr(pt)-1.9* 01:54am blood wbc-13.5* rbc-3.00* hgb-9.5* hct-28.5* mcv-95 mch-31.6 mchc-33.3 rdw-16.6* plt ct-388 01:34am blood wbc-14.4* rbc-2.67* hgb-8.5* hct-25.5* mcv-95 mch-31.7 mchc-33.2 rdw-16.0* plt ct-387 12:56am blood wbc-13.4* rbc-2.76* hgb-8.7* hct-25.8* mcv-93 mch-31.6 mchc-33.9 rdw-15.6* plt ct-367 01:53am blood wbc-13.9* rbc-2.82* hgb-8.9* hct-26.2* mcv-93 mch-31.7 mchc-34.0 rdw-15.4 plt ct-361 05:35am blood wbc-12.5* rbc-2.65* hgb-8.2* hct-25.7* mcv-97 mch-31.1 mchc-32.0 rdw-15.5 plt ct-393 05:00am blood wbc-13.0* rbc-2.54* hgb-7.9* hct-24.5* mcv-96 mch-31.0 mchc-32.2 rdw-16.0* plt ct-386 12:32am blood pt-16.2* ptt-36.0* inr(pt)-1.4* 12:32am blood plt ct-358 05:00am blood plt ct-386 01:54am blood glucose-107* urean-50* creat-1.9* na-140 k-4.4 cl-113* hco3-19* angap-12 12:50am blood glucose-118* urean-54* creat-1.7* na-148* k-3.9 cl-112* hco3-26 angap-14 02:40am blood glucose-113* urean-60* creat-1.6* na-145 k-4.1 cl-111* hco3-25 angap-13 05:00am blood glucose-123* urean-36* creat-1.5* na-143 k-4.3 cl-114* hco3-23 angap-10 05:45am blood glucose-115* urean-36* creat-1.4* na-148* k-4.7 cl-116* hco3-22 angap-15 : eeg: impression: this is an abnormal 24-hour video eeg telemetry due to a low amplitude, poorly organized slow delta frequency background with very low variability. this represents a severe encephalopathy. there were no clear epileptiform discharges or organized seizures seen : cat scan of head: no acute intracranial process : eeg: impression: this 24-hour eeg video telemetry was abnormal due to a generally slow background rhythm and bursts of generalized slowing, which indicate a moderate to severe encephalopathy which may be due to diffuse ischemic, toxic/metabolic, infectious, or other etiologies. there were no clear epileptiform features or electrographic seizures seen : eeg: impression: this is an abnormal video eeg telemetry due to the presence of a slow background which reached a maximum of 6 hz, as well as bursts of generalized slowing, indicative of a moderate to severe encephalopathy, which may be due to diffuse ischemic, toxic/metabolic, infectious, or other etiologies. there were no clear epileptiform features or electrographic seizures noted : ultrasound lower extremities: impression: no evidence of dvt. diffuse soft tissue edema : chest x-ray: findings: in comparison with the study of , the monitoring and support devices remain in place. relatively low lung volumes persist. opacification at the bases most likely represent a combination of pleural effusion and atelectasis. no evidence of acute focal pneumonia or vascular congestion : cat scan of the head: findings: there is no evidence of hemorrhage or infarction. the -white matter differentiation is well preserved. there is no mass, mass effect, or shift of normally midline structures. the ventricles and sulci are prominent in size and configuration likely due to age-related global atrophy, similar in appearance from prior study (). periventricular white matter hypodensities are likely due to chronic small vessel ischemic disease. a right basal ganglia lacunar infarct is again noted. the visualized paranasal sinuses and mastoid air cells are clear. vascular calcifications are noted at the carotid siphons bilaterally : chest x-ray: findings: mild bilateral lower lobe atelectasis is relatively unchanged since . the position of the nasogastric tube, tracheostomy tube, dual chamber pacemaker are unchanged since . the cardiac size is at the upper limits of normal. bilateral superior migration of both glenohumeral joints is mild to moderate in severity. impression: bilateral lower lobe atelectasis, stable since : fluro. abdomen: indication: ivc filter placement findings: a single spot fluoroscopic image obtained intraoperatively without a radiologist present is submitted for review. there is a post-pyloric feeding tube identified, terminating in the midline, likely in the 4th portion of duodenum. there is an ivc filter identified, with the superior tip at the l1-l2 interspace : urine culture: urine culture (final ): yeast. >100,000 organisms/ml.. : gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): ~5000cfu/ml commensal respiratory flora. escherichia coli. 10,000-100,000 organisms/ml.. stenotrophomonas (xanthomonas) maltophilia. 10,000-100,000 organisms/ml.. chloramphenicol = sensitive. timentin = intermediate. ceftazidime, timentin and chlormamphenicol sensitivity testing performed by microscan. levofloxacin sensitivity testing confirmed by microscan. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | stenotrophomonas (xanthomonas) maltoph | | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- <=1 s =>32 r ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s levofloxacin---------- <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r <=1 s : urine urine culture (final ): pseudomonas aeruginosa. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ 2 s meropenem-------------<=0.25 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s brief hospital course: patient was admitted to the trauma icu in the evening of as a transfer from osh. he was intubated and sedated. neurology was consulted to help determine the cause of the patient's continued encephalopathic state. they recommended a ct head without contrast, spinal tap and eeg - all results were negative for hemorrhagic, ischemic and infectious processes. although he had low stoma output initially, this gradually increased following the initiation of tf and after the stoma was digitized. sedation was weaned by hd#3 but the patient continued to be encephalopathic without a known cause. neurology hypothesized that he may have suffererd an ischemic insult at some point during his hospital stay. on hd#3, patient underwent a bedside percutaneous tracheostomy without complication. patient tolerated the procedure well. on hd 7, patient was restarted on his medications including aricept and namenda and his neurological exam and mental status subsequently improved. by hd 9 patient was tolerating trach mask with a strong cough. patient was started on levofloxacin and cefepime for stenotrophomonas growing in his bal and pseudomonas growing in his urine, respectively. his urinary catheter was also replaced at that time. his foley catheter has been discontinued and he has a condom cath in place. his current urine culture reports yeast. he was evaluated by the ostomy nurse on . because of his history of tachy-brady syndrome, his pacemaker was interrogated by the cardiologist on and was determined to be functioning well. lower extremity non-invasives were performed as patient had increased risk for develping dvt. these studies were negative and it was decided to proceed with ivc filter placement to reduce patient's subsequent risk of developing sequelae such as pe from dvt due to his lack of mobility. patient underwent peg and ivc filter placement on hd10 (), he tolerated these procedures well. his tf were restarted through his peg on hd11. these were gradually advanced. due to high residuals, patient was placed on reglan. to treat his elevated ostomy output his tf were supplemented with banana flakes. neurology was consulted for persistently depressed mental status, pt was minimally responsive to verbal stimuli. video eeg monitoring was done and showed diffuse slowing without clear epileptiform activity. while on the surgery service, pt was found to have pneumonia and was started on broad spectrum antibiotics. his renal function began to worsen and he was transferred to medical service for further management. on transfer to medical service, his mental status was unchanged and he was minimally responsive to verbal stimuli and localized to pain. he was more responsive when interacting with wife. was continued on antibiotic coverage for his pneumonia. he had dark output from ostomy and hct drop in setting of worsening cr, transfused 2u rbcs without improvement in renal function. tube feeds were continued but pt had increased residuals and began to have gastric reflux through tracheostomy. tube feeds were stopped. peg tube also had dark output which was gastroccult positive, likely old duodenal ulcer bleeding in setting of infection and coagulopathy. renal was consulted to evaluate worsening renal function given that cr had risen to 4.8. mental status did not improve, likely due to anoxic injury, uremia, hypoactive delirium, and infection. after long discussion between renal team, primary team and patient's wife, the decision was made to make pt comfort measures only. potential for meaningful recovery was low. family meeting was held with primary team and plan for palliative care was discussed at length. hospice care was consulted and pt was continued on morphine, ativan, scopolamine, tylenol for palliative care. trach, peg, and ostomy were kept in place to collect output. pt was comfortable for first 2 days and began to have labored breathing, per wife's request was started on morphine drip. pastoral services and palliative care worked closely with wife to provide comfort care. pt passed away at 6:50am on with wife at bedside. medical examiner accepted case for "viewing", wife elected for autopsy to be performed at with organs donated for educational purposes. pcp notified by phone. medications on admission: : aricept 10', namenda 10'', toprol xl 25/50, asa 81', folic acid 1', ritalin 5', simvastatin 20' discharge medications: expired. discharge disposition: expired discharge diagnosis: colonic perforation c/b unresponsiveness after intubation, sepsis, renal failure. discharge condition: expired. discharge instructions: expired. followup instructions: expired. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung interruption of the vena cava fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy video and radio-telemetered electroencephalographic monitoring diagnoses: acidosis other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation perforation of intestine percutaneous transluminal coronary angioplasty status sepsis acute respiratory failure anoxic brain damage other late effects of cerebrovascular disease old myocardial infarction accidental cut, puncture, perforation or hemorrhage during other specified medical care pneumonia due to escherichia coli [e. coli] cardiac pacemaker in situ encounter for palliative care do not resuscitate status abdominal aneurysm without mention of rupture hyperosmolality and/or hypernatremia septicemia due to escherichia coli [e. coli] pseudomonas infection in conditions classified elsewhere and of unspecified site critical illness polyneuropathy other sedatives and hypnotics causing adverse effects in therapeutic use attention to ileostomy accidental cut, puncture, perforation or hemorrhage during endoscopic examination other hemochromatosis other musculoskeletal symptoms referable to limbs late effect of complications of surgical and medical care need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus] and influenza other complications due to unspecified device, implant, and graft 

Answer: The patient is high likely exposed to