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) / demerol / bacitracin / ciprofloxacin attending: chief complaint: sepsis, abdominal pain major surgical or invasive procedure: central line placement history of present illness: 62 yo female with extensive past medical and surgical history who was just discharged from the surgical service on after undergoing on exploratory laparotomy, extensive lysis of adhesions, abdominal colectomy, end ileostomy, hartmann's pouch creation, transgastric jejunostomy feeding tube placement. she is transferred from where she was admitted for hyponatremia. she also had bilateral flank pain on admit concerning for uti/pyelo. while there, she developed fever, then hypotension today and transferred to the micu. in the micu, she was given broad spectrum antibiotics, stress dose steroids, as well as started on levophed for presumed sepsis. she had blood cultures there which are no growth to date, and urine cultures which showed serratia and e.coli. she had cvl attempt, first subclavian which was unsuccessful, then had a left femoral cvl and a-line placed in sterile condition prior to transfer. she was transferred to the micu here for further evaluation and management of her sepsis as well as surgical evaluation for potential abdominal source of infection. . in the micu, the patient is tired, but able to answer questions. she is unable to provide much history, most of which is obtained from her husband and the medical record. currently, she reports having abdominal pain which started in the last day. she denies abdominal pain prior to that. she denies nausea or vomiting. she does report having fevers and chills in the last day. she is not quite sure about her ostomy output. she did have some mild dysuria. she denies chest pains, shortenss of breath. . review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: adrenocortical insufficiency/congenital adrenal hyperplasia history of addisonian crisis x several episodes neurogenic bladder hashimoto thyroiditis/hypothyroidism insomnia depression glaucoma esophagus restless leg syndrome hypertension -leventhal syndrome gangrenous cholecystitis rectal prolapse psh: tonsillectomy remotely appendectomy, loa, ?ileocecectomy for cecal volvulus vaginoplasty ovarian wedge resection r carpal tunnel release tah-rso (nwh) r tka l tka rye gb () nwh sigmoidectomy/rectopexy () lap ccy lap->open l adrenalectomy () exploratory laparotomy, extensive lysis of adhesions, abdominal colectomy, end ileostomy, hartmann's pouch creation, transgastric jejunostomy feeding tube placement social history: no tobacco or etoh. medical secretary. family history: -mother: no cad. obesity, htn, chf, iddm, ckd on dialysis, depression -father: no cad in family. htn, iddm, afib. physical exam: vitals: t: bp: p: r: 18 o2: general: alert, pale, nad, fatigued but arousable heent: sclera anicteric, mm slightly dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: few bibasilar crackles otherwise clear, no wheezes, ronchi cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended; gj tube in place, no erythema. ileostomy in place with liquid yellow/clear stool. mild erythema around stoma. mild ttp in ruq/rlq and epigastric area with possible rebound. no guarding. ext: slightly cool though perfused, 1+ pulses, no clubbing, cyanosis or edema pertinent results: micro: urine: urine culture preliminary 50-100,000 org/ml serratia marcescens 10-25,000 org/ml escherichia coli 1. serratia marcescens amox/clav r ampicillin r cefazolin r ceftazidime s ceftriaxone s cefuroxime r ciprofloxacin s gentamicin s nitrofurantoin r tetracycline r trim/sulfa s . blood cx: ngtd . images: cxr: limited study. no pneumothorax noted. . kub: no read yet dilated small loops- up to 8.2 cm. no free air. no air/fluid levels. . ekg: sinus tachycardia. no ischemic changes noted. not much different than prior . 03:43am blood wbc-40.7* rbc-3.80* hgb-11.6* hct-34.6* mcv-91 mch-30.5 mchc-33.5 rdw-18.4* plt ct-41* 03:50am blood neuts-34* bands-22* lymphs-7* monos-2 eos-3 baso-0 atyps-3* metas-11* myelos-11* nrbc-1* plasma-0 other-7* 03:43am blood plt ct-41* 03:43am blood fdp-80-160* 01:43pm blood fibrino-636*# d-dimer-as of 03:43am blood glucose-113* urean-24* creat-1.6* na-131* k-4.0 cl-98 hco3-17* angap-20 03:43am blood alt-286* ast-753* alkphos-538* totbili-0.7 03:43am blood albumin-1.9* calcium-5.8* phos-4.6*# mg-2.1 03:43am blood d-dimer-* 03:43am blood triglyc-74 12:30am blood osmolal-260* 12:30am blood vanco-13.7 07:20am blood type-art temp-37.8 rates-22/22 tidal v-400 peep-5 fio2-40 po2-123* pco2-30* ph-7.27* caltco2-14* base xs--11 -assist/con intubat-intubated 07:20am blood lactate-12.9* 10:56pm blood o2 sat-60 07:20am blood freeca-0.79* . cxr endotracheal tube has been advanced. because of relative kyphotic positioning, the tip is not as close to the carina as it appears, but probably not more than 2 cm above it. withdrawal of 1 or 2 cm would be prudent. lung volumes remain quite low and the opacification in the left lower lung medially is probably collapse and may be due to retained secretions. there is no pulmonary edema or evidence for pneumonia in the visible portions of the lung. pleural effusion if any is minimal. moderate cardiomegaly is longstanding. nasogastric tube ends in the distal stomach. intestinal distention is slightly less pronounced today than previously. tip of the new right internal jugular line is low in the right atrium, at least 7 cm beyond the superior cavoatrial junction. no pneumothorax. dr. has been paged. . ct abd/pelv 1. marked small bowel dilatation down to the level of the ileostomy. patchy areas of small bowel wall edema in addition to extensive mesenteric edema. the appearance is very concerning for mechanical obstruction at the level of the ileostomy. severe ileus is, alternatively, possible. 2. small-to-moderate volume ascites. 3. basilar atelectasis and pleural effusions, more marked on the right. 4. degenerative change in the lumbar spine. brief hospital course: assessment and plan: this is a 62 yo female with adrenal insufficiency, hypothyroidism, neurogenic bladder, s/p multiple surgeries most recent on with necrotic colon s/p colectomy with ileostomy, hartmann's pouch, and gj tube placement who was admitted to with hyponatremia, and during that hospitalization started having fevers, abdominal pain, and hypotension . # sepsis: patient has significant leukocytosis (>30k), hypotensive despite fluids now on norepinephrine, fevers, abdominal pain, and urine culture that is positive. the abdominal pain is new, and given her extensive surgical history fairly recently, there is concern for abdominal pathology present. ua not markedly abnormal, but urine culture from with serratia and e.coli. cxr without any focal abnormality but appears to show volume overload likely in the setting of ivfs - will check lfts, amylase, lipase - check coags - cont levophed for map>60 - ivfs boluses prn - check blood, urine, sputum culture - repeat cxr - check ct abdomen for abdominal source of infection - check lactate - stress dose steroids for known adrenal insufficiency, methylprednisolone 100 mg iv q8 - start ceftazidime, vancomycin, and flagyl to cover broad spectrum both urine and gi source - surgical consult for eval of abdomen - npo for now - morphine prn . # adrenal insufficiency: on chronic steroids at home - solumedrol 100 mg iv q8h for now . # hypothyroidsm: on levothyroxine - levothyroxine 87.5 mcg iv daily . # fen: no ivf, replete electrolytes, regular diet . # prophylaxis: subcutaneous heparin . # access: peripherals . # code: full- discussed with patient and husband . # communication: patient and husband . # disposition: pending above . -triple lumen placed -ivig started after talking to gi -order tpn for - deferred a line replacement thrombocytopenia - hypotensive requiring iv boluses - husband updated, agrees to not escalating care . - meeting with husband and discussion of prognosis. decision to make pt . - spoke with from neob who declined pt for organ/tissue recovery. medications on admission: medications on transfer: 1) levophed 2) flagyl 500 mg iv q8h 3) cefepime 2 gm iv q12h 4) vancomycin 1 gm iv q12h 5) solumedrol 100 mg iv q8h - other medications unable to discern on medication list . medications at rehab: acetaminophen 325 mg q4h prn pain calcium +d mirapex 2 mg vitamin d units qmonth on 12th of month levothyroxine 175 mcg daily senna 2 tabs daily prn hydrochlorothiazide 25 mg daily pantoprazole 40 mg daily cyanocobalamin 500 mcg qtuesday/saturday tramadol 50 mg q6h prn pain metoprolol tartrate 50 mg flonase 50 mcg daily prn sanctura 20 mg tab daily plaquenil 200 mg hydromorphone 2 mg prn q3h pain colace 100 mg bimatroprost 1 drop in r eye qhs quinapril 20 mg daily vagifem 25 mcg 1-2x/week for vaginal dryness fludrocortison 0.1 mg qam glucerna 1.0 @ 35 cc/hr immodium 4 mg po if > 4l ostomy output zyprexa 20 mg qhs prednisone 5 mg daily albuterol nebs q6h prn atrovent nebs q6h prn cyclobenzaprine 10 mg tid prn spasms clonazepam 0.5 mg q8h prn anxiety . allergies: sulfa (sulfonamides) / demerol / bacitracin / ciprofloxacin . medications: disposition: expired diagnosis: sepsis condition: patient expired instructions: followup instructions: md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: acidosis long-term (current) use of steroids unspecified septicemia hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism atrial fibrillation hematoma complicating a procedure unspecified glaucoma dysthymic disorder acute respiratory failure septic shock intestinal infection due to clostridium difficile other acquired absence of organ other ascites surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation glucocorticoid deficiency knee joint replacement barrett's esophagus insomnia, unspecified acquired absence of both cervix and uterus restless legs syndrome (rls) other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms nontraumatic compartment syndrome of abdomen pyelonephritis, unspecified neurogenic bladder nos acquired absence of intestine (large) (small) chronic lymphocytic thyroiditis polycystic ovaries 

Answer: The patient is high likely exposed to