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: codeine / demerol / penicillins / erythromycin base attending: chief complaint: fever, somnolence major surgical or invasive procedure: double lumen power picc placed history of present illness: 57 yo f c pbc c/b cirrhosis, hcc s/p segmentectomies x 2 (, ) and recurrence s/p tace of r, l hepatic arteries (, ) c/b biliary ischemia and hepatic abscesses growing separate pansensitive and ciprofloxacin-resistant <i>pseudomonas aeruginosa</i> s/p surgical drain placement in and indefinite inititation of home iv meropenem. interval imaging showed decrease in abscess size in ; her last imaging was a ct scan on and showed no change in abscess size since and showed intrahepatic biliary dilatation, as well as ill-defined opacity in caudate lobe worrisome for tumor recurrence. her afp was documented as 4.2 at that time and she was scheduled for ercp for stent placement. ercp was performed and revealed no evidence of extrahepatic biliary stricturing, diffuse stenosis of intrahepatic ducts with no lesion appropriate for stent placement. . since the ercp, patient has noted increased somnolence and fatigue; she has been falling asleep during conversations and has trouble going up and down stairs. on day prior to admission, she was noted to have temperature on vna assessment of 100.0 and was noted to have wbc count of 2.5 on lab draw. patient said that her skin felt warm but she denied feeling feverish, chills, or night sweats. patient endorses increased abdominal distention and le edema over last two weeks; she is unclear as to whether she has gained weight recently. stable, chronic, non-radiating ruq pain well controlled with oxycodone prn. patient was admitted from clinic today after detailing these complaints for management of suspected infection and possible hepatic encephalopathy. . currently, patient is resting comfortably in the hospital bed and is lucid, oriented x 3, and without acute complaints. . ros: see hpi. patient complains of mild ha, nasal congestion x 2 days with no associated sinus congestion or sob. mild cough x 2 days slightly productive of sputum. altered taste and poor appetite. denies cp, n/v/d/c, dysuria. past medical history: oncologic history 1. : resection of segment vii hcc 2. : resection of segment vi hcc 3. : multifocal hcc in both the left lobe and remainder of right lobe. underwent tace of the right hepatic lobe on 4. : tace of the left hepatic lobe . past medical history: 1. primary biliary cirrhosis diagnosed in . egd on demonstrated normal esophagus without esophageal or gastric varices. 2. ulcerative colitis x10 years. 3. frequent urinary tract infections. 4. hcc s/p segmentectomy social history: she is a dentist who works with her husband in a mutually owned dental practice in . she smoked tobacco between the ages 12 and 19 and does not drink alcohol. family history: significant for primary biliary cirrhosis in one of her sisters. physical exam: vitals - t: 97.1 bp: 90/60 hr: 101 rr: 16 02 sat: 99% ra wt: 61.7 kg general: nad, aaox3 heent: ncat, op clear, mm dry cardiac: rrr s mrg lung: cta with diminished bs at bases bilaterally abdomen: mildly distended, s, mild ttp r side > l side without rebound, guarding, or rigidity, no appreciable fluid wave or shifting dullness ext: wwp, + pitting edema to knees bilaterally, 2+ pulses neuro: derm: spider angiomata on trunk. psych: appropriate affect, intact thought processes and content. pertinent results: labs on admission : 07:34pm urine hours-random urea n-339 creat-48 sodium-less than potassium-27 chloride-11 07:34pm urine osmolal-223 04:46pm glucose-104* urea n-25* creat-0.8 sodium-121* potassium-4.1 chloride-88* total co2-27 anion gap-10 04:46pm alt(sgpt)-78* ast(sgot)-117* alk phos-174* tot bili-18.6* dir bili-14.2* indir bil-4.4 04:46pm albumin-2.6* calcium-8.3* phosphate-3.2 magnesium-2.0 04:46pm osmolal-265* 04:46pm wbc-3.1* rbc-3.85* hgb-11.9* hct-35.3* mcv-92 mch-30.8 mchc-33.7 rdw-15.8* 04:46pm neuts-63 bands-1 lymphs-14* monos-20* eos-0 basos-0 atyps-0 metas-2* myelos-0 04:46pm plt smr-very low plt count-59* 04:46pm pt-17.8* ptt-32.8 inr(pt)-1.6* . ct : 1. clamped right-sided transhepatic pigtail catheter in place with no appreciable change in size of two hepatic abscesses within segments vii and viii since . 2. ill-defined low-attenuating area in caudate lobe concerning for tumor recurrence as suspected on prior ct, is better depicted on multiphasic study of . 3. interval increase in size of a moderate right pleural effusion. 4. cirrhosis with intrahepatic biliary dilatation. unchanged perigastric and perisplenic varices as well as splenomegaly with mass effect on left kidney. . ercp : cannulation of the biliary duct was obtained and contrast medium was injected, revealing a normal-appearing cbd, cystic duct and gallbladder. diffuse narrowing of the intrahepatic ducts is present, consistent with cirrhosis. an area of contrast extravasation at the right posterior intrahepatic duct apparently corresponds to a prior drain site seen on a previous ct examination. . blood cultures positive for pseudomonas aeruginosa. final sensitivities. cefepime & ceftazidime sensitivity testing confirmed by microscan. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- =>64 r ceftazidime----------- 16 i ciprofloxacin--------- 1 s gentamicin------------ <=1 s meropenem------------- =>16 r piperacillin/tazo----- 64 s tobramycin------------ <=1 s . ruq u/s : nodular cirrhotic liver with a dominant 2.6-cm mass in the caudate lobe and several smaller suspicious nodules scattered elsewhere. doppler assessment is normal. there is no residual fluid collection seen following prior drainage. gallstones and splenomegaly also noted. . echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no obvious vegetations . ct abd/pelvis : impression: 1. removal of the right transhepatic drainage catheter with reaccumulation of fluid posterior to the right hepatic lobe. 2. new areas of low attenuation in both hepatic lobes, the largest in the left hepatic lobe measures 2.7 cm, concerning for new hepatic abscesses. 3. caudate lobe mass consistent with growing hepatocellular carcinoma. multiple treated hcc as before. . brief hospital course: this is a 58 year female with history of pbc complicated by cirrhosis, hcc s/p surgical resection, hcc recurrence s/p tace complicated by biliary ischemia and hepatic abscesses s/p surgical drain placement and iv abx who presented with somnolence as well as fevers and was found to be hyponatremic with recurrent hepatic abscesses and blood cultures positive for mdr pseudomonas. . #. mdr pseudomonas bacteremia, hepatic abscesses: the patient's blood cultures were positive for mdr pseudomonas from likely secondary to recurrent hepatic abscesses which were discovered on a ct scan. the pseudomonas was cefepime/meropenem resistant, ceftazidime intermediate resistance, and cipro/zosyn sensitive. a tte was negative for any vegetations. the infectious disease consult service followed the patient closely throughout her admission. her old picc line was discontinued and she was started on cipro monotherapy given her documented allergy to penicillin. a new double lumen power picc was placed on after the patient had been blood culture negative and afebrile for several days. she was also desensitized to penicillin per micu protocol and started on zosyn prior to discharge. zosyn/cipro will be continued indefinitely with the clinic following surveillance labs. interventional radiology was consulted for hepatic abscess drainage, but felt that the abscesses were small enough where antibiotic penetration would be possible without drainage. . #. hcc: a ct abdomen/pelvis performed on demonstrated progression of her known hcc as well as recurrent hepatic abscesses with no significant ascites. her meld score was 22 on discharge, but the patient is not a transplant candidate. she was treated with lactulose, lasix, aldactone, cholestyramine, ursodiol, and oxycodone with only minor modifcations in dosing when compared to her previous home regimen. . #. ams/somnolence: likely secondary to hyponatremia (na=121 on admission) along with a component of hepatic encephalopathy. mental status improved to baseline and patient was alert and oriented times 3 on discharge after sodium correction with fluid restrcition and administration of lactulose. . #. ulcerative colitis: remained stable. the patient's home mesalamine regimen was continued. . #. code: the patient's code status was established as dnr/dni this admission following a conversation with the patient and her family concerning her poor prognosis given her worsening liver failure secondary to treatment refractory, progressive hcc. . #. dispo: home with hospice services and iv cipro/zosyn medications on admission: calcitonin 200u spray 1 hs questran 4g qday folic acid 1 mg qd lasix 40 mg qd meropenem 1g iv q8h mesalamine 1.2g tid mesalamine enema qd oxycodone 5-10 mg q8-12h prn pain compazine 5mg q12-24h prn nausea spironolactone 100 mg qd ursodiol 500 mg vit c 500 qd-tid ca/vit d 500/200 mvi cranberry extract 500 qd discharge medications: 1. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: one (1) spray nasal hs (at bedtime). 2. cholestyramine-sucrose 4 gram packet sig: one (1) packet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po tid (3 times a day). 5. mesalamine 4 gram/60 ml enema sig: one (1) enema rectal hs (at bedtime). 6. ursodiol 250 mg tablet sig: two (2) tablet po bid (2 times a day). 7. ascorbic acid 250 mg tablet, chewable sig: two (2) tablet, chewable po bid (2 times a day). 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. magnesium oxide 140 mg capsule sig: two (2) capsule po daily (daily). 11. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po daily (daily). disp:*1 bottle* refills:*2* 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. spironolactone 100 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 14. oxycodone 5 mg tablet sig: to 1 tablet po every four (4) hours as needed for pain. 15. ciprofloxacin 400 mg/40 ml solution sig: four hundred (400) mg intravenous twice a day. disp:*qs * refills:*2* 16. zosyn 4.5 gram recon soln sig: 4.5 grams intravenous every eight (8) hours. disp:*qs * refills:*2* 17. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush. disp:*qs ml(s)* refills:*0* 18. compazine 5 mg tablet sig: one (1) tablet po every twelve (12) hours as needed for nausea. 19. oxycodone 5 mg/5 ml solution sig: 2.5 ml po every six (6) hours as needed for pain. disp:*2 bottle* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: hepatic abscesses multi drug resistant pseudomonas bacteremia primary biliary cirrhosis hepatocellular carcinoma secondary diagnoses: - ulcerative colitis discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were admitted to hospital for evaluation of fevers and fatigue. you were found to have recurrent liver abscesses and your blood was infected with an antibiotic resistant bacteria called pseudomonas. your old picc was removed as a result of the infection and a new one was placed several days later for continued long term iv antibiotic treatment. you were desensitized to pencillin and will be started on an extended course of zosyn (a stronger penicillin related antibiotic) and cipro. it appears that the abscesses are too small to be drained at this time and should respond to your antibiotic regimen. unfortunately, it also appears as though your known liver cancer continues to progress despite all the treatments you have received. . the following changes have been made to your home medication regimen: - you will be on zosyn 4.5 grams iv every 8 hours indefinitely - you will be on ciprofloxaxin 400mg iv twice daily indefinitely - your home furosemide dose has been decreased to 20mg daily - your home spironolactone dose has been decreased to 50mg daily - you will be started on lactulose which should be titrated to help ensure daily bowel movements . please follow-up with your scheduled appointments listed below. followup instructions: please follow-up with your scheduled appointments listed below: . 1. provider: , md phone: date/time: 9:30 . 2. provider: , md phone: date/time: 11:40 . 3. provider: , m.d. phone: date/time: 2:30 procedure: venous catheterization, not elsewhere classified diagnoses: hypocalcemia hyposmolality and/or hyponatremia bacteremia osteoporosis, unspecified abscess of liver altered mental status malignant neoplasm of liver, primary ulcerative colitis, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site jaundice, unspecified, not of newborn biliary cirrhosis 

Answer: The patient is high likely exposed to