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: sulfa (sulfonamides) / salmon oil / nut flavor attending: chief complaint: abdominal pain, nausea, vomiting, diarrhea x5days. major surgical or invasive procedure: : exploratory laparotomy, lysis of adhesions, detorsion of the bowel. history of present illness: ms. is a 68 year old female who had an open aaa repair in of last year. she went to an outside hospital (osh) complaining of 5d of non-bloody diarrhea and 3d of gradually worsening abdominal pain, as well as nausea/vomiting for the past day or so. denies fevers and chills. she underwent a ct scan of the abdomen/pelvis at the osh which was concerning for small bowel ischemia, and was transferred to for further workup. on arrival here she was found to be intermittently hypotensive to the 60s, with fluctuating sats, and intermittently obtunded. she complains of midepigastric abdominal pain when she is awake. but otherwise denies any other complaints. past medical history: pmhx: htn, copd not on home o2 with doe (50 ft with walker), depression, obesity, peripheral vascular disease, aaa and bilateral ica occlusion, urinary incontinence. . pshx: cholecystectomy, appendectomy, perforated ulcers x3, hysterectomy, bilateral total knee replacements. social history: marital status: divorced. tobacco use: yes: number of cigarettes per day: 3 cigarettes. number of years: 1. previous smoker: yes: number of years: 50. alcohol use: 1 drinks per week. recreational drugs: no. family history: non-contributory. physical exam: on admission: vs: t 98.5, hr 94, bp 102/56, rr 14, 96% on 2l gen: obese. intermittently obtunded, but aaox3 when awake heent: anicteric. dry mucosal membranes. neck: no jvd. no lad. no tm. cv: rrr. pulm: ctab. abd: soft. + tender to palpation at mid epigastrium but no rebound, no guarding dre: not done ext: cool, clammy, distal pulses intact . at discharge: avss/afebrile gen: elderly, obese female in nad. heent: anicteric. o-p clear. neck: supple. lungs: cta(b) cor: rrr abd: protuberant. midline incision with staples c/d/i with 2 approx. 1-1.5cm incisional wounds, which are clean, granulating. moist-to-dry packing placed with dsd cover. bsx4. appopriately tender to palpation along incision, otherwsie soft/nt/nd. extrem: left arm picc patent/intact with clean dressing. wwp; no c/c/e. neuro: a+ox3. pertinent results: on admission: 09:07pm type-art po2-101 pco2-39 ph-7.30* total co2-20* base xs--6 09:07pm k+-3.2* 06:38pm type-art po2-88 pco2-38 ph-7.30* total co2-19* base xs--6 06:38pm lactate-2.5* 06:38pm freeca-1.13 04:02pm type-art po2-105 pco2-42 ph-7.27* total co2-20* base xs--7 04:02pm glucose-166* lactate-2.1* k+-3.5 04:02pm freeca-1.11* 11:43am urine color-yellow appear-clear sp -1.025 11:43am urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-5.5 leuk-neg 10:13am type-art po2-104 pco2-41 ph-7.26* total co2-19* base xs--8 10:13am lactate-1.4 07:35am phosphate-3.9 magnesium-2.1 07:35am potassium-4.2 11:10pm wbc-14.0* rbc-5.95*# hgb-18.5*# hct-56.9*# mcv-96 mch-31.1 mchc-32.6 rdw-13.7 11:10pm neuts-88.6* lymphs-6.1* monos-5.0 eos-0.1 basos-0.2 11:10pm plt count-345 . prior to discharge: 07:05am blood wbc-12.2* rbc-3.65* hgb-11.8* hct-35.4* mcv-97 mch-32.4* mchc-33.4 rdw-13.4 plt ct-384 07:05am blood glucose-87 urean-23* creat-0.7 na-142 k-3.3 cl-101 hco3-34* angap-10 07:05am blood calcium-8.6 phos-2.8 mg-1.9 07:28am blood vanco-13.1 . imaging: osh ct scan: lack of enhancement of small bowel concerning for ischemia, possible closed loop obstruction vs. mid gut volvulus, sma patent until region of mesenteric swirling then disappears. + free intraabdominal fluid. . chest port. line placem: findings: in comparison with the study of , there has been placement of a left subclavian picc line that extends to the upper portion of the svc. right ij catheter remains in place. dobbhoff tube has been removed. brief hospital course: the patient was transferred from an outside hospital (osh) on and was admitted to the general surgical service on for emergent exploratory laparotomy for high grade small bowel obstruction. in the emergency room, the patient was found to be intermittently hypotensive to the 60s, with fluctuating saturations, and intermittently obtunded. she was intubated for inabilty to maintain sats in the ed. early on , the patient underwent exploratory laparotomy, lysis of adhesions, detorsion of the bowel, which went well without complication (reader referred to the operative note for details). after a brief, uneventful stay in the pacu, the patient was transferred to the sicu for post-operative care. the patient was hemodynamically stable. . neuro: post-operatively, the patient initially received fentanyl, then morphine iv prn with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications with continued good effect. she remained neurologically intact. . cv: initially hypotensive secondary to question of sirs and intravascular volume depletion, which responded to iv fluid rescusitation, electrolyte repletion and administration of albumin. patient then became hypertensive post-operatively, which required the initialtion of metoprolol iv, as well as multiple doses of iv lasix and hydralazine. when tolerating a diet, iv metoprolol was transitioned to the oral formulation and the patient no longer required iv hydralazine with good blood pressure control. the patient subsequently remained stable from a cardiovascular standpoint; vital signs were routinely monitored. . pulmonary: as above, the patient was intubated in the ed. post-operatively, she was kept intubated secondary to the metabilic and respiratory acidosis. she was extubated on pod#1, but then re-intubated on pod#4 due to hypoxemic respiratory failure beleived to be due to an acute exacerbation of her underlying copd. she was started on methylprednisone, around-the-clock nebulizer treatments, and humidification. on pod#5, iv vancomycin and zosyn were also started. she was diuresed. these intervetions proved effective, and by pod#6, she was extubated and subsequently remained stable. good pulmonary toilet, early ambulation and incentive spirrometry as well as use of her home inhalers and prn nebulizer treatments were continued throughout hospitalization. at discharge, she was on liters by nasal cannula to maintain her sao2 >93-94%. . gi/gu/fen: post-operatively, the patient was made npo with iv fluids. the patient self-discontinued her ngt on pod#2, which was replaced, but then later removed on pod#4. a dobbhoff was placed, and tubefeeds started on pod#5. on pod#6, she was started on sips. her diet was progressively advanced to regular by pod#7, which was well tolerated, and tubefeeds discontinued. foley was discontinued on pod#8; she subsequently voided without problem. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. . id: given re-intubation due to possible copd exacerbation versus pneumonia, the patient was empirically started on iv vancomycin and zosyn on pod#5 after the patient was pan-cultured. sputum gram stain revealed gprs, gnrs, and gps and the urine culture grew mrsa. sputum also later grew e. coli and mrsa. it was determined that the patient would require iv vancomycin and cipro until , thus a picc line was placed. the patient's white blood count and fever curves were closely watched for signs of infection. wound care: after staples removed on pod#9, two incisional wounds opened up along inferior aspect, requiring moist-to-dry packing, which continued at discharge. wounds were clean and granulating. . endocrine: the patient's blood sugar was monitored throughout his stay; sliding scale insulin was administered when indicated. . hematology: the patient's complete blood count was examined routinely; no blood 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. . at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating with assitance, voiding without assistance, and pain was well controlled. she was discharged to an extended care faciltiy for further nursing care and rehabiliation. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. hydrochlorothiazide dose unknown 12. triamterene dose unknown 13. chantix discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 3. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 8. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. ciprofloxacin 750 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days: completion date: . 12. hydralazine 10 mg iv q6h:prn sbp more than 160 13. diphenhydramine 12.5-25 mg iv q6h:prn prn agitation start with 12.5mg dose please 14. 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. 15. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous every twelve (12) hours for 10 days: completion date: . discharge disposition: extended care facility: at discharge diagnosis: 1. ischemic bowel from the adhesions with volvulus. 2. copd with exacerbation. 3. metabolic and respiratory acidosis. 4. acute renal failure. discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: provider: , md phone: date/time: 11:45. location: 3, , , . . please call ( to arrange a follow-up appointment with dr. (pcp) in weeks. . provider: , orthopedic private practice phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances other lysis of peritoneal adhesions intra-abdominal manipulation of small intestine diagnoses: acidosis anemia, unspecified tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified acute respiratory failure other ascites methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site obesity, unspecified acute vascular insufficiency of intestine knee joint replacement delirium due to conditions classified elsewhere volvulus volume depletion, unspecified intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) 

Answer: The patient is high likely exposed to