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: nitrofurantoin / yellow dye / iron / calcium attending: chief complaint: nausea, vomiting, abdominal pain major surgical or invasive procedure: : eus : egd with duodenal stricture dilation. biopsies taken of pyloric ulcer. eus performed with peri-gastric lymphnode biopsy. : vagotomy and antrectomy with b2 reconstruction. : re-exploration with placement of lateral duodenostomy tube and feeding jejunostomy tube. : successful ct-guided catheter drainage of liver abscess history of present illness: 66 year-old woman with gastric outlet obstruction from a pyloric ulcer and duodenal stricture status post dilitation by dr. on , who was admitted to hospital on with vomiting and abdominal pain as well as diarrhea for 2 days. diarrhea was new. stool was watery and profuse. her abdominal pain was mild and located in the upper abdomen. she felt weak and had mild chills and diaphoresis. at hospital, her wbc is noted to be 18 on admit, which came down to 9. kub showed dilated stomach. her symptoms initially improved and diet was advanced to pureed diet, but this triggered further nausea, abdominal cramps. she was transferred to further management. she currently has mild crampy abdominal pain periumbilical and lower abdomen, no epigastric symptoms. no nasuea currently, her symptoms of cramping are post prandial, her nausea is intermittent and not related to food intake. her diarrhea which was profuse and watery lasted only 24 hours on wednesday and has completely resolved. no bleeding. mild fatigue. chills lasted for one day, and have resolved. denies chest pain and shortness of breath. review of systems is otherwise negative. past medical history: pmh: chronic back pain, sciatica, htn, pud, adrenal adenoma, uterine ca s/p hysterectomy psh: perforated cyst/appendix s/p sbr, appendectomy, cystectomy as a teenager, s/p hysterectomy at age 29 for uterine cancer. : lisinopril 20', ppi, vicodin, soma(muscle relaxant) social history: lives with husband. , half pack per day. denies alcohol use. family history: father with peptic ulcer disease physical exam: admission p/e: vs: t 96.7 hr 80 bp 152/70 rr 16 o2 100% on ra gen: no acute distress heent: mucous membranes moist, oropharynx clear neck: supple cv: regular rate and rhythm, no murmurs, rubs or gallops. chest: clear to auscultation bilaterally abd: soft, mild periumbilical tenderness, no rebound or guarding, normal bowel sounds present. ext: warm and well perfused. no lower extremity edema. skin: no rash neuro: alert and oriented to person, place, and time. moves all four extremities, fluent speech, normal 5/5 strength upper and lower extremities. psych: calm, appropriate discharge p/e: pertinent results: kub 1. no bowel obstruction, free air or wall thickening 2. stomach is distended with both gas and fluid kub: no free air on supine radiographs. ct abdomen with contrast : 1. diffuse symmetric thickening of the gastric wall at the level of the pylorus, with few perigastric lymph nodes. these findings are concerning for a gastric malignancy with local lymph nodal disease. 2. no evidence of distant metastases in the abdomen and pelvis. 3. multiple bilateral adrenal lesions, consistent with adenomas. gastric ulcer biopsy: 1. antral/pyloric-type mucosa with extensive ulceration, granulation tissue formation, acute and chronic inflammation and focal reactive epithelial changes. 2. no dysplasia is identified. note: immunostain for h. pylori is in progress; results will be reported in an addendum. case reviewed by dr. . , who concurs. 3. immunostain is negative for h. pylori, with satisfactory controls. lymph node biopsy: cytology interpretation non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by lymphoma are not seen in specimen. correlation with clinical findings is recommended. flow cytometry immunophenotyping may not detect all lymphomas as due to topography, sampling or artifacts of sample preparation. abd ct: impression: 1. large inflammatory phlegmon involving the transverse mesocolon extending up to the right subhepatic space where it is continuous with a small air and fluid collection adjacent to the gallbladder. given its location, this would be extremely difficult to access percutaneously. however, there may be a small access window posterolaterally on the right. also of note, there is very little fluid within this inflammatory phlegmon, though a very large percutaneous drain would be required to drain it. 2. stable left adrenal nodule which remains indeterminate. 3. enlarged mesenteric lymph nodes are likely reactive. 4. bilateral pleural effusions are moderate. abd ct: impression: 1. slight decrease in size of fluid collections along segment iv of the liver as well as the peri-pancreatic collections. 2. unchanged size and appearance of collection in the transverse mesocolon. 3. narrowing of the smv as it crosses the duodenum and t-tube without venous thrombus, increased from the prior study. 4. stable left adrenal nodule which remains indeterminate. 5. decreased size of bilateral pleural effusions and associated compressive atelectasis. abd ct: impression: 1. large liver abscess, new compared with prior. there is associated periportal edema and gallbladder wall edema related to systemic inflammation. 2. t-tube remains in place within the duodenal stump with near complete resolution of previously described fluid collection. there is a moderate amount of free fluid within the pelvis. cardiac echo: conclusions the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels 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. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. micro: 12:50 pm blood culture ( myco/f lytic bottle) source: line-picc. blood/fungal culture (preliminary): due to overgrowth of bacteria,. unable to continue monitoring for fungus. enterobacter cloacae. identification and sensitivities performed on culture # 320-4294g . enterococcus faecium. identification and sensitivities performed on culture # . enterobacter cloacae. identification and sensitivities performed on culture # 320-4294g . staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus and species. reported to and read back by @ 3:05pm . final sensitivities. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. daptomycin susceptibility testing requested by dr. . daptomycin and linezolid susceptibility testing requested by dr. . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r linezolid------------- 2 s oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s blood/afb culture (final ): due to overgrowth of bacteria,. unable to continue monitoring for afb. myco-f bottle gram stain (final ): gram positive cocci in pairs and chains. gram negative rod(s). 3:30 pm blood culture blood culture, routine (preliminary): this is a corrected report 1825. reported to and read back by # @1820. enterobacter cloacae. identification and sensitivities performed on culture # 320-4294g . enterococcus sp.. identification and sensitivities performed on culture # 320-4294g . enterobacter cloacae. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. piperacillin/tazobactam sensitivity testing performed by . previously reported as ( @1442). bactrim (=septra=sulfa x trimeth) sensitivity testing performed by . bactrim (=septra=sulfa x trimeth) = intermediate. enterobacter cloacae. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. piperacillin/tazobactam sensitivity testing confirmed by . previously reported as ( @1442). bactrim (=septra=sulfa x trimeth) sensitivity testing confirmed by . bactrim (=septra=sulfa x trimeth) = resistant. clostridium species. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | enterobacter cloacae | | cefepime-------------- <=1 s <=1 s ceftazidime----------- =>64 r =>64 r ceftriaxone----------- =>64 r 32 i ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- i =>128 r tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s anaerobic bottle gram stain (final ): this is a corrected report 12:50pm . reported to and read back by @ 12:18 . gram negative rod(s). gram positive cocci in pairs and chains. gram positive rod(s) consistent with clostridium or bacillus species. previously reported without gram positive rod(s) . aerobic bottle gram stain (final ): gram positive cocci in pairs and chains. gram negative rod(s). 1:15 am abscess source: ct perc drained liver abscess. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): enterobacter cloacae. sparse growth. piperacillin/tazobactam sensitivity testing performed by . this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. enterococcus sp.. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | enterococcus sp. | | ampicillin------------ =>32 r cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s linezolid------------- 2 s meropenem-------------<=0.25 s penicillin g---------- =>64 r piperacillin/tazo----- i tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s vancomycin------------ =>32 r anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): no fungus isolated. 7:10 am blood culture set#2. blood culture, routine (pending): 1:39 pm stool consistency: formed source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: the patient is a 66 year-old woman with gastric outlet obstruction from pyloric ulcer and duodenal stricturing s/p duodenal balloon dilation on and without improvement in symptoms. patient could not tolerate pos without increase in nausea, vomiting, and abdominal pain. transferred to surgery service on to prepare for gastrojejunostomy. on , the patient underwent vagotomy and antrectomy with b2 reconstruction, which went well without complication (reader referred to the operative note for details). after a brief, uneventful stay in the pacu, the patient arrived on the floor npo with ngt, on iv fluids and antibiotics, with a foley catheter, and epidural catheter for pain control. the patient was hemodynamically stable. on , (pod2), the patient's drain output turned bilious and she developed peritonitis on exam, concerning for duodenal stump leak. the patient was brought back to or, and underwent re-exploration with placement of lateral duodenostomy tube and feeding jejunostomy tube. post operatively in the pacu, the patient was tachycardic and was given iv metoprolol 5mg x 2 with good effect. the patient's epidural was adjusted by aps. when stable, the patient was transferred on the floor in satisfactory condition. the patient's recovery course was complicated by prolonged diarrhea tube feeding despite multiple changes of feed, abdominal cramps relieved by hyoscyamine, liver abscess and bacteremia/sepsis. neuro: the patient has a history of chronic back and abdominal pain, she is on vicodin and soma at home prior admission. post operatively, the patient received bupivacaine/hydromorphone via epidural catheter for pain control. the epidural was split on pod # 1 hypotension/tachycardia on bupivacaine via epidural and dilaudid pca. the pain was adequately controlled. the patient was started on toradol after second operation for better pain control. when tolerating oral intake, the patient was transitioned to oral pain medications regiment. the patient's pain was not adequately controlled on home medications regiment and vicodin was changed to dilaudid po. the patient was restarted on soma, hyoscyamine was added to help with abdominal cramps. currently the patient's pain is adequately controlled. cv: the patient was tachycardic and hypertensive postoperatively, her symptoms were treated with iv metoprolol and her epidural was splitted. the patient's heart rate was monitored with telemetry device. telemetry was discontinued on and the patient remained stable from a cardiovascular standpoint. on , the patient was found hypotensive with sbp 30-70s, the patient was transferred into the icu. she was intubated and she was required levothed to control her bp. this episode of hypotension was bacteremia/sepsis, bp improved on . pressors were discontinued and the patient was extubated. the patient was transferred back on the floor in stable position. vital signs were checked regularly and were stable. cardiac echo was done on to rule out endocarditis. echo revealed normal lvef > 55% and was grossly normal. the patient will continue on lisinopril and metoprolol to control her bp and hr. pulmonary: the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. on the patient received large amount of fluid hypotension, she developed sob and wheezing and was intubated in the icu. the patient was extubated on without difficulties. chest x-ray revealed bilateral small pleural effusions. the patient remained stable from pulmonary standpoint. gi: on the patient underwent picc line placement and tpn was started. the patient was continued on tpn until . the patient was started on trophic tube feed (fibersource) on . the patient developed severe abdominal cramps and tf was held. the tf was restarted on and was advanced to 60 cc/hr. tf was held again severe abdominal cramps and diarrhea. the patient's tf was on and off, and on tf was changed to vivonex. the patient continued to have significant diarrhea and abdominal cramps. she was started on reglan and hyoscyamine, tf was changed to isosource on . the patient's diarrhea and abdominal cramps decreased. nutritional service was consulted with goal to educate patient about post partial gastrectomy diet. the patient was started on clear liquids on and her diet was advanced to regular post gastrectomy diet on . the tf was discontinued on , the patient currently tolerating regular diet. electrolytes were routinely followed, and repleted when necessary. id: the patient's was afebrile with normal wbc on admission, her urine cultures were negative. on , the patient was taken back in or to fix her duodenal stump leak, postoperatively the patient was started on iv flagyl and cipro as empirical treatment for possible peritonitis. the abx was changed on to vancomycin/zosyn. on wbc went up to 26 and fluconazole was started. the patient completed course of vanco/zosyn/fluconazole and all abx were discontinued on . the patient's wbc was 12 on and continued to downward. on , the patient's stool was checked for c-diff diarrhea and was negative for c-diff. on , the patient wbc went up to 36.2, she was found hypotensive with sob. picc line was removed and cultured, blood cultures were sent for microbiology as well. the patient was transferred into icu, abdominal ct revealed large liver abscess. the patient underwent ir guided drainage of the abscess and jp drain placement on . the patient's blood and abscess cultures came back positive for multiple organisms including vre and mrsa. infectious diseases was called for consult and patient was started on meropenem/linezolid iv per id recs. the patient's wbc reached 48.4 and started to downward. the antibiotics regiment was changed prior discharge to ertapenem and daptomycin per id recs. the patient remains afebrile. she will continue on iv abx until her follow up with id on . wound care: the patient's midline incision healed well and currently open to air. the patient's d-tube started to leak around the tube on , ostomy/wound nurse was called for consult. the patient's d-tube was connected to ostomy appliance. currently, d-tube continued to have minimal leak around the tube, the tube is capped and attached to small ostomy pouch. jp drain located in the liver bed and it's to bulb suction, site is clear/dry and intact. drains should remain as is, while at rehab and will be reevaluated in follow up. endocrine: the patient's blood sugar was monitored throughout his stay; no insulin administration was required. hematology: the patient has baseline anemia with hct 30s on admission. the patient's hct was stable between 23-28 postoperatively. on , the patient was found to have hct 21.2, she received 3 units of rbc total. post transfusion hct was 28.8. the patient's hct remained stable until discharge no more transfusions were required. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible with pt. at the time of discharge in rehab, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating with assist, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: prilosec 40mg po lisinopril 20mg po daily vicodin premarin 1.25mg soma 350 tid discharge medications: 1. carisoprodol 350 mg tablet sig: one (1) tablet po tid (3 times a day). 2. conjugated estrogens 0.625 mg tablet sig: one (1) tablet po daily (daily). 3. calcium carbonate 200 mg (500 mg) tablet, chewable sig: tablet, chewables po qid (4 times a day) as needed for heartburn. 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. hyoscyamine sulfate 0.375 mg capsule,extended release 12 hr sig: one (1) capsule,extended release 12 hr po daily (daily). disp:*30 capsule,extended release 12 hr(s)* refills:*2* 6. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). disp:*120 tablet(s)* refills:*2* 7. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). 8. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 9. multivitamin tablet, chewable sig: one (1) tablet, chewable po once a day. 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for mouth yeast. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). tablet, delayed release (e.c.)(s) 13. conjugated estrogens 0.625 mg tablet sig: one (1) tablet po daily (daily). 14. diphenoxylate-atropine 2.5-0.025 mg tablet sig: one (1) tablet po bid (2 times a day): hold if constipated. 15. ertapenem 1 gram recon soln sig: one (1) recon soln injection q24hr (): give until follow up with id on . 16. daptomycin 300 mg iv q24h 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: hospital for continuing medical care- discharge diagnosis: 1. gastric outlet obstruction 2. peptic ulcer disease. 3. duodenal stump leak 4. tachycadria 5. liver abscess 6. sepsis 7. chronic pain 8. anemia of chronic disease 9. depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid. discharge instructions: you were admitted to the pancreatobiliary surgery service for an antrectomy, vagotomy and bilroth ii reconstruction for gastric outlet obstruction. this was complicated by a duodenal stump leak requiring exploratory laparotomy, repair, placement of a duodenostomy tube, liver abscess requiring percutaneous drain placement, and bacteremia general discharge instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please take the prescribed analgesic medications as needed. you may not drive or heavy machinery while taking narcotic analgesic medications. you may also take acetaminophen (tylenol) as directed, but do not exceed 4000 mg in one day. please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. duodenostomy drain care: *please look at the drain site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warmth, and fever). *keep drain open into the pouch. the pouch needs to be changed every 3 days, nurses will assist you with changes. *record the color, consistency, and amount of fluid from around the drain. call the surgeon, nurse practitioner, or nurse if the amount increases significantly or changes in character. *change the pouch system q72h or prn. *you may shower and wash the drain site gently with warm, soapy water. you may also wash with half strength hydrogen peroxide followed by saline rinse. *keep the insertion site clean and dry otherwise. place a drain sponge for cleanliness. *avoid swimming, baths, and hot tubs. do not submerge yourself in water. *attach the drain securely to your body to prevent pulling or dislocation. jejunostomy tube care: *similar to drain care as above. *flush with 30cc sterile water every 8 hours. jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *you may shower; wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . picc line: *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. followup instructions: radiology: you scheduled for abdominal ct scan on . please arrive in radiology department at 9 am for registration. please do not eat after midnight on . radiology located: , , , provider: , md phone: date/time: 12:45 , , , . provider: , m.d. phone: date/time: 1:50 infectious clinic, bld, . provider: , m.d. phone: date/time: 1:50 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other enterostomy insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization esophagogastroduodenoscopy [egd] with closed biopsy biopsy of lymphatic structure partial gastrectomy with anastomosis to jejunum percutaneous aspiration of liver dilation of intestine injection or infusion of oxazolidinone class of antibiotics vagotomy, not otherwise specified central venous catheter placement with guidance diagnoses: sciatica other chronic pain esophageal reflux tobacco use disorder other postoperative infection unspecified pleural effusion unspecified protein-calorie malnutrition severe sepsis atrial flutter candidiasis of mouth surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation septic shock abscess of liver other septicemia due to gram-negative organisms diarrhea dehydration lumbago streptococcal septicemia personal history of malignant neoplasm of cervix uteri abdominal pain, generalized leukocytosis, unspecified acquired absence of both cervix and uterus other suppurative peritonitis benign essential hypertension acquired hypertrophic pyloric stenosis abscess of intestine body mass index less than 19, adult other obstruction of duodenum other acute postoperative pain chronic gastric ulcer without mention of hemorrhage or perforation, with obstruction 

Answer: The patient is high likely exposed to