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: history of present illness: the patient is a 76 year-old male with a chief complaint of shortness of breath. the patient was discharged home on status post a whipple procedure on . the patient had an uneventful pylorus preserving pancreaticoduodenectomy with open cholecystectomy and incidental meckel's diverticulectomy. the surgery was indicated on the basis of a periampullary mass identified on endoscopy. prior to the patient's discharge there was no indication of an problem. his laboratory values were acceptable. he had low output from his drain, and the drain amylase was checked and found to be less than 3. there drain was therefore pulled prior to his discharge. at home, the patient became ill. he complained of weakness and shortness of breath. however, he denied fever, vomiting, pain or cough. he had had no bowel movement since his discharge ten days prior. past medical history: 1. ampullary adenoma status post whipple as above. 2. hypertension. 3. coronary artery disease, status post coronary artery bypass graft, status post exercise mibi with no perfusion defects. 4. diabetes mellitus. 5. chronic renal failure. 6. hypercholesterolemia. medications at home: 1. lopressor 50 mg b.i.d. 2. nifedipine sr 60 mg p.o. q.d. 3. protonix 40 mg p.o. q.d. 4. reglan p.r.n. 5. percocet p.r.n. 6. ambien p.r.n. allergies: no known drug allergies. physical examination: 96.3, 82, 94/27, 24, 93 percent on 2 liters. general: awake and alert, oriented times three, weak. lungs: crackles bilaterally. cardiac: regular rate and rhythm. abdomen: soft, nontender, wound healing well. peripheral: mild edema (no change). relevant laboratory studies: hematocrit 23 (down from 29.5 on ). sodium 127, potassium 4.7, chloride 91, hco3, bicarbonate 16, bun 113, creatinine 6.6, glucose 252, ast 21, alt 23, alk phos 160, total bilirubin 2.2, albumin 2.5. chest x-ray: no congestive heart failure, no consolidation. electrocardiogram: q waves lead, avf, no systematic changes from ecg of . impression: a 76 year-old male, status post whipple procedure with uncomplicated postoperative course now with increasing shortness of breath, decrease in blood pressure and hematocrit of 23. also with apparently worsening renal failure, possibly secondary to dehydration. hospital course: the night of admission the patient's shortness of breath increased and his saturations decreased to 90 percent on a nonrebreather with a respiration rate of 40. the arterial blood gas showed hypoxia but a vk scan was negative. the patient was transferred to the unit, intubated, and ruled out for a myocardial infarction. the patient also received two units of packed red blood cells and hydration. the following day the patient received two additional units of packed red blood cells bringing his hematocrit up to 37.9. the patient underwent an abdominal ct which showed free air in the abdomen consistent with an anastomotic leak. some of the free air was noted to be in the afferent limb of the base of the liver. because of the findings on ct scan the patient was taken to the operating room where he underwent drainage of an intra-abdominal/ retroperitoneal abscess, control of an early postoperative pancreatic fistula, placement of gastrostomy tube, and placement of a feeding jejunostomy tube. the patient was found to have dehiscence of the anterior aspect of his pancreaticojejunostomy and a regional intra-abdominal/ retroperitoneal abscess. please see dictated operative note for further details. the culture of an intraoperative swab was later found to be growing enterococcus gram negative rods, lactobacillus, and presumptive clostridium perfringens. postoperatively the patient was initially placed on broad spectrum antibiotics consistent with vancomycin, levofloxacin and flagyl. postoperatively the patient exhibited a septic picture requiring continuing levophed in order to maintain his blood pressures. the patient was also placed on cdbh for his acute and chronic renal failure and in order to properly regulate his blood volumes. the patient was followed closely by a renal consulting team for his acute and chronic renal failure. on postoperative day two the patient experienced two bouts of rapid atrial fibrillation with hypotension. the patient was cardioverted but then returned to rapid atrial fibrillation. the patient was then treated with an amiodarone drip. the patient's blood pressures then stabilized at 110/50. a cardiology consult was obtained for the new onset rapid atrial fibrillation. they point out that atrial fibrillation in the setting of sirs with levophed is not unusual and amiodarone and hemodialysis is the appropriate action. therefore, the amiodarone was continued along with the dccv. by postoperative day three the patient's levophed requirement began to decrease. however, he was still in refractory atrial fibrillation. amiodarone was therefore continued. the patient was also begun on trophic feeding through his j tube. on postoperative day five the patient required continuing cvvh, one unit packed red blood cells for decreasing hematocrit and levophed weaning was begun. an infectious disease consult was obtained for the blood cultures previously mentioned along with the fact that the drain output transitioned to some creamy appearance. the patient was switched over the vancomycin, meropenem, clindamycin and fluconazole for his cultures, the worst of which was the clostridium perfringens. the patient also had a sputum culture showing klebsiella pneumonia and consolidation or collapse in the retrocardiac area along with an ill defined opacity in the right lung base. by postoperative day seven the patient was continuing to be weaned from levophed along with weaning from the peep respirator. his tube feeds had increased to 40 cc an hour. by postoperative day ten the patient was off levophed, continued to be treated for his klebsiella pneumonia along with the clostridium perfringens in his swab with vancomycin, meropenem, clindamycin, and fluconazole. the patient continued on cvvh. his sedation was weaned but he continued to be intubated. his examination by this point showed a soft nontender abdomen. by postoperative day 11 the patient was off of the amiodarone drip with no more atrial fibrillation. patient was slowly being weaned from the ventilator and the tube feeds were slowly being advanced to goal rate. the patient continued to receive intravenous antibiotics. the wound was noted to have some fibrinous exudate along the edges and required surgical debridement back to bleeding surfaces. by postoperative day 14 the patient's propofol was discontinued, vent weaning was continued, cvvh was planned for an additional two to three days, antibiotics were continued and the patient's status continued to improve. on postoperative day 16 the patient's wound continued to be an area of concern with bile draining from the midportion of the incision. the plans were made to switch the patient over to hemodialysis. tube feeds were switched to 2/3 strength. over the next few days the wound drainage decreased and the wound looked clean. on postoperative day 19 the patient's antibiotics were discontinued. the patient had two c. diffs drawn that were negative on and . the patient continued on hemodialysis. by postoperative day 20 the patient was noted to have a soft nontender abdomen with no drainage from the wound. it was being packed at times with wet to dry dressings. the patient was transferred to the floor and followed a fairly uneventful course except for periods of periodic bradycardia for which his hypertension medications were adjusted. the patient also was found to have a vancomycin resistant enterococcal urinary tract infection for which he was treated with a seen day course of linezolid. the patient also had several hemodialysis catheter changes that took place while he was on the floor. because of some changes in the patient's mental status he underwent a ct of his head which showed scattered white matter hypodensities consistent with small vessel disease but no acute events. the patient also experienced some temperature spikes more than a week prior to his discharge for which he received blood cultures which were ultimately negative. nevertheless, the patient was placed on levo and flagyl for a few days out of concern that the patient was septicemic. the patient's hemodialysis quintin catheter was also removed during one of these periods of elevated temperatures. this appeared to help. the removal of the hemodialysis catheter necessitated a new hemodialysis catheter which was placed a few days later, this one again temporary. the patient received a permanent hemodialysis tunneled catheter on as the patient had remained afebrile for several days. a few days prior to discharge the patient had continued to have a benign abdomen suggesting no intra-abdominal process. the patient remained afebrile. the patient did have a chest x-ray showing a left pleural effusion but had good oxygen saturations and was not short of breath. as the patient's mental status was excellent the patient on postoperative 38, , the patient's white blood cell count remained normal and the patient's abdominal wound was improving, the patient was discharged to a rehabilitation facility. condition on discharge: stable. disposition: to rehabilitation facility. discharge diagnosis: in addition to the admitting diagnosis, the patient experienced: 1. atrial fibrillation. 2. end stage renal disease. 3. klebsiella pneumonia. 4. anastomotic dehiscence, status post whipple procedure. 5. vre urinary tract infection. discharge medications: to be dictated. follow up plans: the patient is to follow up with dr. in one to two weeks. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis incision of abdominal wall atrial cardioversion transfusion of packed cells other gastrostomy revision of anastomosis of small intestine injection or infusion of oxazolidinone class of antibiotics diagnoses: other postoperative infection urinary tract infection, site not specified acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified septicemia atrial fibrillation disruption of internal operation (surgical) wound septic shock pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to