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: no known allergies / adverse drug reactions attending: chief complaint: malpositioned g-tube sepsis major surgical or invasive procedure: exploratory g tube tract incision and drainage of the retro rectus and peri rectus space, and drain placement g tube placement history of present illness: 52m with anoxic brain injury secondary to substance abuse s/p tracheostomy, peg placement , transferred from osh for g-tube malpositioning. pt underwent manual g-tube replacement at his rehab facility yesterday, after which water-soluble contrast was injected to confirm placement. it is unclear whether tube feeds were administered via this new g-tube. when residuals became bloody, the pt was transferred to an osh for ct imaging. at the osh the pt became febrile to 102.5, tachycardic, and was found to have a leukocytosis >18,000. ct a/p revealed a malpositioned g-tube located in the left rectus muscle, accompanied by air and fluid. the pt was subsequently transfered to for further management; a surgical consult is requested for g-tube evaluation. past medical history: pmh: tbi secondary to anoxia during substance overdose psh: tracheostomy and peg placement social history: resides at longterm care facility. family history: n/c physical exam: admission physical exam vitals: 98.9 122 146/86 28 97% trach collar gen: pt non-verbal. awake. heent: perrl. no scleral icterus. mucous membranes moist. cv: regular rhythm but tachycardic pulm: rhonchi clear w/ suctioning. abd: soft, nondistended, appears nontender. g-tube in place with palpable superficial positioning. mild fullness appreciated over left upper rectus muscle. ext: le warm without edema. physical examination upon discharge: vital signs: t=98.5, hr=109, bp=118/75, rr=16, 95% room air cv: rrr lungs: coarse rhonchi throughout abdomen: soft, button left side abdomen with dsd ext: cool feet bil., no pedal edema, contractures of upper ext. neuro: opens eyes to tactile stimuli, spontaneous cough skin: stage 2 ulcer left heel pertinent results: 05:04am blood wbc-11.4* rbc-4.50* hgb-14.4 hct-44.2 mcv-98 mch-31.9 mchc-32.5 rdw-13.8 plt ct-408 05:04am blood plt ct-408 05:04am blood glucose-125* urean-20 creat-0.8 na-135 k-4.8 cl-96 hco3-24 angap-20 05:06am blood alt-33 ast-20 alkphos-46 totbili-0.8 05:04am blood calcium-10.1 phos-3.7 mg-2.4 05:35am blood wbc-10.8 rbc-4.37* hgb-14.1 hct-42.3 mcv-97 mch-32.2* mchc-33.2 rdw-13.7 plt ct-393 05:35am blood plt ct-393 05:35am blood glucose-140* urean-19 creat-0.8 na-138 k-4.5 cl-100 hco3-25 angap-18 05:06am blood alt-33 ast-20 alkphos-46 totbili-0.8 05:35am blood calcium-9.7 phos-4.0 mg-2.5 01:30pm blood wbc-6.7 rbc-3.32* hgb-11.0* hct-30.9* mcv-93 mch-33.0* mchc-35.5* rdw-13.6 plt ct-398 04:57am blood wbc-6.3 rbc-3.55* hgb-11.4* hct-33.4* mcv-94 mch-32.2* mchc-34.2 rdw-13.3 plt ct-365 05:06am blood wbc-9.8# rbc-3.20* hgb-10.4* hct-31.2* mcv-98 mch-32.6* mchc-33.4 rdw-13.6 plt ct-309 01:30pm blood plt ct-398 01:30pm blood pt-14.9* ptt-28.5 inr(pt)-1.4* 04:45am blood glucose-151* urean-5* creat-0.6 na-135 k-3.4 cl-97 hco3-27 angap-14 01:30pm blood glucose-99 urean-7 creat-0.5 na-137 k-3.3 cl-100 hco3-24 angap-16 05:06am blood alt-33 ast-20 alkphos-46 totbili-0.8 12:43am blood alt-60* ast-37 alkphos-58 totbili-2.5* 09:35pm blood alt-55* ast-34 alkphos-54 totbili-2.5* 04:45am blood calcium-8.5 phos-3.6 mg-1.8 04:57am blood vanco-18.3 09:00pm blood vanco-5.0* urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. this isolate demonstrates carbapenemase production. consider infectious disease consultation.. sensitive to doxycycline. sensitive to minocycline. doxycycline and minocycline sensitivity testing performed by . isolate sent to laboratories for colistin susceptibility testing. . cefepime = intermediate (mic: 16mcg/ml) results were obtained by altenative method (micoscan). meropenem sensitivity testing performed by microscan. sensitive to tigecycline (mic: <=1 mcg/ml). sensitive to tetracycline (mic: <=4 mcg/ml). tigecycline and tetracycline sensitivity testing performed by microscan. colistin <=2 mcg/ml, sensitivity performed by laboratories . pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | pseudomonas aeruginosa | | amikacin-------------- 8 s ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- 2 s 32 r ceftazidime----------- =>64 r 32 r ceftriaxone----------- 16 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s =>16 r meropenem------------- 8 r 2 s nitrofurantoin-------- 256 r piperacillin/tazo----- s tobramycin------------ =>16 r 8 i trimethoprim/sulfa---- <=1 s mrsa screen (final ): positive for methicillin resistant staph aureus. / 3:00 am urine source: catheter. **final report ** urine culture (final ): klebsiella pneumoniae. 10,000-100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. klebsiella pneumoniae. 10,000-100,000 organisms/ml.. second morphology. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | klebsiella pneumoniae | | ampicillin/sulbactam-- =>32 r =>32 r cefazolin------------- =>64 r =>64 r cefepime-------------- 2 s 2 s ceftazidime----------- =>64 r =>64 r ceftriaxone----------- 16 r 16 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem------------- 1 s 1 s nitrofurantoin-------- 256 r 256 r tobramycin------------ =>16 r =>16 r trimethoprim/sulfa---- <=1 s <=1 s time taken not noted log-in date/time: 2:52 pm immunology **final report ** hcv viral load (final ): 270,276 iu/ml. performed using the cobas ampliprep / cobas taqman hcv test. linear range of quantification: 43 iu/ml - 69 million iu/ml. limit of detection: 18 iu/ml. rare instances of underquantification of hcv genotype 4 samples by cobas ampliprep/cobas taqman hcv test method used in our laboratory may occur, generally in the range of 10 to 100 fold underquantitation. if your patient has hcv genotype 4 virus and if clinically appropriate, please contact the molecular diagnostics laboratory () so that results can be confirmed by an alternate methodology. : chest x-ray: impression: no significant interval change. left basilar opacity, potentially due to atelectasis, effusion; however, consolidation from infection is not excluded. : g/gj/tube check: after administration of gastrografin via the gastrostomy tube in supine and semi-upright positions, there was normal opacification of the stomach without evidence of leak. subsequently, a total of one liter of gastrografin was administered via the gastrostomy tube and images of the stomach and small bowel were obtained without evidence of small-bowel obstruction, and noleak/extravasation was seen at the gastrostomy site. impression: no evidence of leak or bowel obstruction. brief hospital course: mr was admitted from the emergency department and taken to the operating room for debridement of his gastrostomy tube site. he was monitored in the intensive care unit for approximately 12 hours before being transferred to the surgical floor on hd #3. his hospital course is outlined below by organ system: neurologic: he did not appear to have any changes from his baseline neurological dysfunction (unable to follow commands, does not speak). he opens his eyes to tactile stimuli. he has a spontaneous cough and is able to clear his secretions via his trach tube. cardiovascular: he was in sinus tachycardia post-operatively, presumed to be from his systemic inflammatory response from the g-tube site infection and/or uti. he was given intermittent intravenous metoprolol with good effect. his metoprolol continues via the feeding tube. after his surgical debridment, he has been afebrile. his white blood cell count has decreased to 7. he continues to have episodes of tachycardia controlled with metroprolol. pulmonary: he had clear secretions from his tracheostomy site. he had no evidence of pneumonia on chest x-ray. he had a strong spontaneous cough and was able to expectorate secretions via his trach. gastrointestinal: his prior g-tube was removed in the operating room on hd #1. -gastric tube was placed and later changed to a dobhoff with the resumption of feedings. the patient removed both the -gastric tube and the dobhoff. after replacement of the dobhoff, the patient once again removed it. in order to provide him with nutrition, he was taken to the operating room on hd #6 where he had placment of gastrostomy tube. his tube feedings were resumed and he has attained his goal. on pod #6, he began having emesis and his g-tube was placed to gravity drainage. he was started on reglan and underwent a x-ray of the abdomen which showed gaseous distention of the stomach. he was placed on bowel rest for 24 hours. his tube feedings were resumed within 24 hours with tolerance of the tube feedings. he was noted at this time to have mild erythema around the stoma site with mild macular lesions extending beyond the stoma. he was started on nystatin powder and his abdominal binder was removed. his tube feedings were changed from continuous to cyclic tube feedings to lessen his chance of removing the tube. on hd # 19, he was reported to have bloody ooze from the stoma edges which did not resolve with pressure. silver nitrate was applied to the bleeding edges and the oozing subsided. his hematocrit has remained stable at 42. his g-tube was removed on hd # 22, and a #14 foley catheter was placed into the stoma tract with resumption of cyclic tube feedings. the tube was buttoned and cyclic feedings resumed. renal: he had a chronic foley and presented with a very dirty urine specimen. a urine culture showed klebsiella. his foley was changed on arrival to the intensive care unit. he was treated with empiric vancomycin, zosyn, and cefepime for both the presumed uti and abdominal wall collection. his antibiotics were discontinued on hd #5. his final urine culture report did identify pseudomonas and klebseilla. his foley catheter was reinserted on hd #10 because of ineffective urine collection with the condom catheter. upon insertion of the catheter, he was found to have cloudy urine and a urine specimen was sent. his foley was left in place and a repeat urine done on hd #12 did again grow klebseilla and pseudomonas. he was started on a 1 week course of bactrim with completion of the course on . he was still showing cloudy urine after completion of the bactrim. his foley was again changed on hd #22. the urine appeared to be clearer with less sediment. he was again ordered for an additional week of bactrim. hematology: his hematocrit has remained stable. he was maintained on subcutaneous heparin during his stay. endocrine: his blood sugar was controlled by an insulin sliding scale. skin: he was found to have left heel pressure ulcers and erythematous coccyx. wound consult was called and recommmended waffle boots and frequent repositioning. he has contractures of his upper extremities. he has been out of bed into the chair utlizing a lift. excoration around the tube treated with application of a dry dressin. social: social services and case management have been involved in his discharge planning. a court appointed guardian has been selected and discharge to a extended care facility has been undertaken. . medications on admission: metoprolol, unknown doseage discharge medications: 1. colace 60 mg/15 ml syrup sig: twenty five (25) cc po twice a day: via g-tube, hold for loose stool. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) cc injection tid (3 times a day). 3. bisacodyl 10 mg suppository sig: one (1) rectal once a day as needed for constipation. 4. miralax 17 gram/dose powder sig: seventeen (17) gms po once a day as needed for constipation. 5. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation: via g tube. 6. ascorbic acid 500 mg/5 ml syrup sig: five hundred (500) mg po daily (daily): via g tube. 7. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day): apply around g tube site. 8. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain/fever. 9. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours): via g tube. 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for systolic blood presure <110, hr <60. 11. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day): week course, stop date . discharge disposition: extended care facility: highgate manor discharge diagnosis: malpositioned g-tube urosepsis discharge condition: non-verbal, opens eyes to tactile stimuli oob ( lift) discharge instructions: you were admitted to the hospital due to a mal-positioned feeding tube. you were also found to have an elevated white blood cell count and fever. your urine specimen grew some bacteria. you were started on antibiotics in the emergency room. you were monitored in the intensive care unit and later went to the operating room for abdominal exploration, removal of feeding tube, placement of jp drain, and placement of -gastric tube. you were transferred to the surgical floor 24 hours later. you were started on tube feedings via the -gastric tube. the feeding tube was later changed to a dobhoff tube and tube feedings resumed. you removed the dobhoff tube. you were taken to the operating room for placement of an open gastrostomy and the tube feedings were resumed. a special button was placed into the gastrostomy stoma to provide cyclic feedings and reduce the chance of removal the tube. your vital signs have been stable and you have been afebrile. your antibiotics have been discontinued. you are preparing for discharge to your rehabiilitation facility where you can continue to receive care. followup instructions: department: general surgery/ name: dr. when: tuesday at 1:30 pm with: acute care clinic building: lm bldg () campus: west best parking: garage name: , a specialty: primary care location: medical group address: , , phone: *please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. procedure: enteral infusion of concentrated nutritional substances percutaneous abdominal drainage incision of abdominal wall other gastrostomy removal of gastrostomy tube diagnoses: urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site other specified cardiac dysrhythmias anoxic brain damage pressure ulcer, heel pseudomonas infection in conditions classified elsewhere and of unspecified site tracheostomy status infection of gastrostomy mechanical complication of gastrostomy pressure ulcer, stage ii 

Answer: The patient is high likely exposed to