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: humira / toradol / certolizumab pegol / meperidine attending: chief complaint: abdominal pain, increased ostomy output, nausea/vomiting major surgical or invasive procedure: right internal jugular triple lumen catheter placement, revision, and replacement by interventional radiology 1 unit packed red blood cell transfusion history of present illness: 34 yo f with pmhx significant for crohn's disease s/p near-total colectomy and ileostomy, pe/ue dvt on lovenox with recent hospitalization - for stomal pain and found to have fungemia/bacteremia now s/p portacath removal who presents to the ed with persistent stomal pain, increased stool output and nausea/vomiting. . patient was last admitted from for abdominal pain, nausea, vomiting, and increased ostomy output. during that admission she underwent ileoscopy, endoscopy and flexible sigmoidoscopy which were normal and showed no signs of active crohns; infectious work-up was negative and mre was unrevealing. inflammatory markers were normal and her steroids were tapered (initially started on methylprednisolone 20 iv q8h for presumed crohns flare), which she finished on . colorectal surgery thought patient had a stomal prolapse however should not be causing the degree of pain she reported. ultimately thought that the pain was due to irritation of the stoma due to increased stool output. patient offered reversal of ostomy and has appointment on with dr. at to discuss (wanted infection to clear prior to or). patient started on loperamide to decrease stool output. blood cultures during that admission grew staph epidermidis as well as , and she was started on a course of linezolid and fluconazole; linezolid was planned to be finished on (although patient finished yesterday) and fluconazole on (still taking). patient's portacath was removed and a right ij tlc was placed for acess during the remainder of her hospital stay. patient has very poor access and has required multiple portacaths. found to have a rue axillary and left ij dvt for which she is managed with lovenox, reportedly non-compliant as an outpatient (although denies this). while awaiting insurance authorization of linezolid she left against medical advice, however obtained prior auth as an outpatient. since discharge, the patient reports that she has continued to have stomal pain, worse with passage of stool. pain describd as burning/pressure pain. also with increased stool output, watery without any visible blood although reportedly guaiac positive at per patient. patient finished her prednisone taper on with no change in symptoms. also with one day of nausea/vomiting, unable to take po. denies any fever, chills, cp or sob. . ed: initially seen at ed where a small piv was placed and patient given 500 cc of ns until iv access lost. given po zofran and im dilaudid. labs drawn and significant for normal wbc's, sodium 133 and k+ 3.1. no lfts drawn. patient transferred to . vitals: 98.8 108p 107/61 16 99%ra. given zofran 4mg odt x 2 and dilaudid 1mg im. . ros as per hpi, 10 pt ros otherwise negative past medical history: --crohn's disease - previously on inflixamab, now s/p near total colectomy and ileostomy with recent extensive work-up showing no active crohn's --difficult access with portacath s/p removal due to fungemia/bacteremia --dvts (left ij and right ue axillary) - provoked in setting of portacath --pe social history: lives with husband, and six children plus one granddtr. denies alcohol use, tobacco use, and any history of illicit drugs. works for family business - catering. family history: no significant gi or hematologic history physical exam: vs: 97.0 127/88 107p 18 99%ra appearance: alert, nad, obese eyes: eomi, perrl, anicteric ent: op clear s lesions, mm very dry, no jvd, neck supple cv: +s1, s2 -m/r/g, no peripheral edema, 2+ dp/pt bilaterally pulm: clear bilaterally abd: soft, right side of abdomen with ttp, no distension, +bs, no rebound/guarding, stoma pink with mild prolapse msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing neuro: cn 2-12 grossly intact, no focal deficits skin: multiple scars on chest from previous portacaths, right upper arm small lesion with sutures after biopsy psych: appropriate, pleasant heme: no cervical pertinent results: no labs available on admission. labs: . 133 103 12 ------------< 88 3.1 22 0.7 . 6.9> 8.3/25.5 <181 mcv 79 . coags wnl . ua negative . mre: 1. chronic inflammatory changes in the terminal ileum without convincing evidence of acute disease. no definite fistula seen although this is a somewhat suboptimal study due to patient's difficulty drinking oral contrast. 2. bilateral hemorrhagic ovarian cysts. mild bilateral hydrosalpinges. . ue doppler: occlusive thrombus in the right axillary vein extending into the proximal basilic vein. the extent of clot is unchanged compared to . . bilateral ue doppler at : thrombosed left ij, occlusive thrombus right axillary veing extending proximal basilic vein 05:50am blood wbc-5.1 rbc-2.80* hgb-6.9* hct-22.3* mcv-80* mch-24.5* mchc-30.8* rdw-18.6* plt ct-200 05:52am blood wbc-4.3 rbc-2.87* hgb-7.1* hct-23.1* mcv-81* mch-24.6* mchc-30.5* rdw-19.1* plt ct-205 04:26am blood wbc-4.4 rbc-2.82* hgb-6.9* hct-22.8* mcv-81* mch-24.7* mchc-30.5* rdw-18.9* plt ct-200 04:10am blood wbc-5.8 rbc-2.99* hgb-7.4* hct-24.3* mcv-81* mch-24.8* mchc-30.6* rdw-19.0* plt ct-206 06:21am blood wbc-6.0 rbc-2.99* hgb-7.3* hct-24.4* mcv-81* mch-24.4* mchc-29.9* rdw-19.3* plt ct-153 06:10am blood wbc-4.7 rbc-3.03* hgb-7.5* hct-24.5* mcv-81* mch-24.7* mchc-30.5* rdw-19.7* plt ct-138* 06:26am blood wbc-3.8* rbc-3.10* hgb-7.8* hct-25.3* mcv-82 mch-25.0* mchc-30.7* rdw-19.5* plt ct-164 01:12am blood wbc-4.1 rbc-3.04* hgb-7.5* hct-24.5* mcv-81* mch-24.8* mchc-30.8* rdw-19.1* plt ct-129* 04:40am blood wbc-4.5 rbc-2.83* hgb-7.0* hct-22.7* mcv-80* mch-24.7* mchc-30.8* rdw-19.3* plt ct-108* 06:17am blood wbc-5.0# rbc-2.37* hgb-5.8* hct-19.1* mcv-81* mch-24.5* mchc-30.4* rdw-20.5* plt ct-101* 09:20am blood wbc-2.8* rbc-2.86* hgb-7.1* hct-22.9* mcv-80* mch-24.8* mchc-31.0 rdw-20.3* plt ct-169 05:33am blood wbc-2.5* rbc-2.50* hgb-6.2* hct-20.3* mcv-81* mch-24.7* mchc-30.3* rdw-20.5* plt ct-135* 12:18pm blood wbc-2.9* rbc-2.72* hgb-6.7* hct-22.2* mcv-81* mch-24.6* mchc-30.2* rdw-20.7* plt ct-142* 04:01pm blood wbc-3.3* rbc-2.76* hgb-6.8* hct-22.3* mcv-81* mch-24.6* mchc-30.4* rdw-22.1* plt ct-134* 06:25am blood wbc-2.8* rbc-2.54* hgb-6.3* hct-21.0* mcv-82 mch-24.8* mchc-30.1* rdw-20.7* plt ct-109* 04:32pm blood wbc-3.6* rbc-2.95* hgb-7.4* hct-24.0* mcv-81* mch-25.1* mchc-31.0 rdw-21.9* plt ct-150# 05:58am blood wbc-3.8* rbc-2.64* hgb-6.5* hct-21.7* mcv-82 mch-24.7* mchc-30.0* rdw-21.5* plt ct-93* 12:00pm blood wbc-4.7 rbc-2.94*# hgb-7.4*# hct-23.9*# mcv-81* mch-25.2* mchc-31.0 rdw-22.6* plt ct-136*# 03:04am blood wbc-3.5*# rbc-4.65# hgb-11.3*# hct-37.9# mcv-81* mch-24.3* mchc-29.9* rdw-22.4* plt ct-78* 06:10am blood neuts-66 bands-1 lymphs-22 monos-8 eos-1 baso-1 atyps-0 metas-0 myelos-0 plasma-1* 03:04am blood neuts-68.4 lymphs-24.3 monos-6.3 eos-0.6 baso-0.3 05:50am blood pt-11.3 ptt-86.0* inr(pt)-1.0 06:17am blood fibrino-347 01:12am blood esr-58* 03:04am blood esr-20 09:20am blood ret aut-3.3* 05:50am blood glucose-89 urean-12 creat-0.5 na-137 k-3.6 cl-103 hco3-26 angap-12 05:52am blood glucose-119* urean-10 creat-0.6 na-137 k-3.8 cl-105 hco3-25 angap-11 04:26am blood alt-16 ast-23 alkphos-75 totbili-0.2 08:00am blood alt-11 ast-18 alkphos-69 totbili-0.3 06:26am blood alt-23 ast-17 alkphos-89 totbili-0.8 01:12am blood alt-32 ast-26 alkphos-89 totbili-0.9 dirbili-0.3 indbili-0.6 06:17am blood alt-47* ast-43* alkphos-104 totbili-1.0 09:20am blood alt-61* ast-52* alkphos-112* totbili-0.8 05:33am blood alt-58* ast-47* alkphos-108* totbili-0.6 12:18pm blood alt-62* ast-42* alkphos-117* totbili-0.7 06:25am blood alt-77* ast-53* alkphos-129* totbili-0.7 04:32pm blood alt-93* ast-63* alkphos-135* totbili-0.8 12:54pm blood alt-105* ast-82* alkphos-139* totbili-0.8 03:04am blood alt-102* ast-88* alkphos-133* amylase-48 totbili-0.9 04:26am blood lipase-41 06:17am blood lipase-11 03:04am blood lipase-29 09:20am blood caltibc-545* ferritn-43 trf-419* 12:54pm blood vitb12-279 09:20am blood tsh-0.21* 04:40am blood t4-6.4 01:12am blood anca-negative b 01:12am blood -negative 01:12am blood crp-66.9* 03:04am blood crp-13.5* 01:12am blood c3-137 c4-38 03:04am blood strongyloides antibody,igg-test name . cxr: impression: persistent unusual medial course of right internal jugular central venous catheter, which courses more medially than a previous right internal jugular venous catheter present on prior chest x-rays and ct scans in . position on lateral view excludes internal mammary vein location and suggests a central venous location, but inadvertent arterial placement cannot be excluded. . kub : impression: no evidence of obstruction or ileus. . mri chest: impression: 1. multifocal areas of thrombosis within the venous system of the upper extremities bilaterally including near total occlusion of the svc and left brachiocephalic vein by thrombus, and non-occlusive thrombus in the right internal jugular and at the junction of the right internal jugular and subclavian veins on the right. left internal jugular vein is completely occluded, with numerous collaterals visualized. 2. 2.5 x 1.6 cm retropharyngeal fluid collection in the cervical spine, concerning for reaccumulation of the patient's prior abscess. re-evaluation with dedicated mr of the neck with contrast is recommended. 3. 3.3 x 1.9 cm subcutaneous hyperintense area relative to skeletal muscle on images in the region of the prior placement of the port, presumed to be a hematoma. the pertinent findings were discussed dr. , the covering physician, telephone at 5:30 p.m. on . . ruq u/s: impression: no evidence of intra- or extra-hepatic ductal dilatation to suggest cholestasis. . replacement of tlc: impression: 1. uncomplicated svc gram demonstrating near-complete occlusion of the mid to lower svc, non-occlusive thrombus extending into the left brachiocephalic vein, multiple venous collaterals. 2. uncomplicated replacement of the old 7 french 15 cm triple-lumen central venous catheter with a new 7 french 20-cm triple-lumen central venous catheter, with its tip in the upper right atrium. catheter is ready for use. . mri c-spine: impression: study is quite limited by motion artifact, but demonstrates: 1. ill-defined fusiform fluid/edema in the prevertebral space, extending from the c1 through c7 level. this is, overall, less marked than on the previous mr study of and demonstrates no definite rim- or internal enhancement to suggest true collection or abscess. 2. no finding to suggest spondylodiscitis or its complications, such as epidural phlegmon or abscess. 3. normal cervical spinal cord caliber and intrinsic signal intensity. . comment: these findings were discussed with dr. ( hospitalist, covering for dr. , the requesting clinician) via telephone, at 1745 h on . apparently, the patient has known "svc syndrome" with documented venous thrombosis, over the entire time period dating to early , which likely accounts for the persistent retropharyngeal/prevertebral edema. as discussed, in this setting, the role of continued dedicated imaging of the cervical spine and soft tissues is unclear. . ct abd/pelvis : impression: 1. no evidence of obstruction or abscess. stranding around ileostomy is unchanged since and is likely chronic. 2. simple free fluid within the pelvis. 3. hypodensity within the right lobe of the liver, too small to characterize, most likely a cyst. 4. multiple collateral vessels in the right subcutaneous tissues which correlates with patient's history of known bilateral ij and subclavian occlusion . echo: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a very small pericardial effusion. no vegetation seen (cannot definitively exclude). compared with the prior study (images reviewed) of , findings are similar. . r/ij: conclusion: 1. placement of a triple-lumen central venous line into the right atrium over the guide wire through the existing access in the right internal jugular vein. 2. the line is ready to use. . kub: bowel gas pattern is unremarkable. there is air and stool seen throughout colon. no dilated loops of small bowel are identified. bony structures are intact. there is no free intra-abdominal gas seen on the left side downdecubitus radiographs. . mri neck: impression: 1. ill-defined fluid/edema in the prevertebral spaces from c1-c7 is significantly decreased since the prior exam. no evidence of abnormal enhancement. 2. stable degenerative changes of the cervical spine, and mild downward displacement of the cerebellar tonsils. . blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-final inpatient catheter tip-iv wound culture-final inpatient blood culture blood culture, routine-final {enterobacter cloacae complex, enterobacter cloacae complex}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final inpatient 9:50 am blood culture source: line-ij #2. **final report ** blood culture, routine (final ): ertapenem sensitivity testing padival #. enterobacter cloacae complex. final sensitivities. 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. ertapenem sensitive sensitivity testing performed by . enterobacter cloacae complex. second morphology. final sensitivities. 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. ertapenem sensitive sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae complex | enterobacter cloacae complex | | cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- s s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s blood culture blood culture, routine-final inpatient stool c. difficile dna amplification assay-final; fecal culture-final; campylobacter culture-final inpatient blood culture blood culture, routine-final {enterobacter cloacae complex, enterobacter cloacae complex}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final inpatient blood culture blood culture, routine-final {enterobacter cloacae complex, enterobacter cloacae complex}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final {enterobacter cloacae complex, enterobacter cloacae complex}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final inpatient urine urine culture-final inpatient blood culture blood culture, routine-final inpatient stool c. difficile dna amplification assay-final; fecal culture-final; campylobacter culture-final; fecal culture - r/o vibrio-final; fecal culture - r/o yersinia-final; fecal culture - r/o e.coli 0157:h7-final; ova + parasites-final brief hospital course: ## venous thrombosis/svc syndrome: mrv showed large amount of clot burden in upper central venous system with total occlusion of left ij and subtotal occlusion of the right ij and svc. she was on lovenox at home and was transitioned to a heparin gtt this admission. given her difficult access, a right ij was placed by the micu attending on the floor prior to transfer. this was changed for a longer 20cm line by ir while in the and was functioning well at the time of transfer. the etiology of her extensive clotting was thought to be a combination of hypercoagulability from her crohn's, endothelial damage from her multiple prior ports and potentially a familial thrombophilia. heme/onc was consulted regarding her extensive thrombus and recommended continuing heparin drip while in house with plans to transition to coumadin while bridging for a minimum of 48hrs. in addition, should the patient become subtherapeutic ever, she will require rebridging with iv heparin or lovenox at 100mg . ir is planning to take her for angioplasty, kissing stent placement, and port placement for a planned admission to the day after her iv antibiotic course is complete (see below). the vascular service was consulted, however, the team felt that there was no current indication for thrombectomy and no procedures should be performed until either the patient has been line free x1 month or at least until after her abx course is complete. she will need to be transitioned back to either lovenox or iv heparin prior to her ir admission. as all of the thromboses have been line-related, the hematology service did not recommend ordering a hypercoagulable work-up, although this may be considered at a later date given the history of thrombophilia in her mother and brother. the hematology service will be following up with the patient in about 3weeks after discharge. -starting coumadin 5mg on . she has been on a continuous iv heparin infusion. she will need to be bridged for at least 48hrs while therapeutic. should absorption or recurrent n/v become an issue or pt is to become subtherapeutic, she will need to be bridged with iv heparin or lovenox 100mg . should absorption become a recurrent issue, pt should then be placed on lovenox 100mg with a factor 10a level to be checked after 3rd dose. . ## access issues-pt has very complicated vascular access. see above. there was much debate among the vascular service, ir, (line specialist), and id as what would be the best approach for the patient. there was some consideration of removing the pt's r.ij (that has been changed over a wire twice) and placing temporary, possibly tunneled, groin access. however, this was felt to place the patient at high risk for infection given her prior infections and prolonged planned course of iv abx. in addition, should she clot groin access, she will be left in a difficult place as she no longer has any upper extremity access (other than r.ij above).therefore, it was decided to keep her current temporary r.ij in place while continuing antibiotic therapy and anticoagulation. then, the patient is to return for a scheduled admission to the day after her antibiotics are complete ( or ) for an ir procedure to place kissing stents, angioplasty and for port placement. . ## high-grade enterobacter bacteremia: patient developed worsening abdominal pain and fevers. blood cultures grew pan-sensitive enterobacter. started on zosyn but was persistently bacteremic. thus, the id service recommended switching to meropenem for better clot penetration as there was concern of superinfected thrombosis. (there is no plan for thrombectomy/intervention at this time) at that time, the original internal jugular catheter was exchanged over a wire. this was then performed a second time. the first negative blood culture after these measures were taken was . surface echo was negative for vegetations. ct abdomen was unremarkable for intraabdominal fluid collection to suggest a gi source. the id team followed the patient closely during admission. the id team has recommended 4 weeks of iv meropenem. pt should have weekly safetly labs (cbc with diff, chem 7, lfts) while on meropenem. pt should have a repeat blood culture with gram stain the day the antibiotics are to be completed. last day of therapy for 4 week course is . pt will need repeat bcx and gram stain day abx course is complete. ## retropharyngeal fluid collection on mri: concern for abscess. ent/ir felt this was a reaccumulation of a previous hematoma from port placement and thought that instrumentation to that area could introduce infection. with no fevers/leukocytosis it was decided to have repeat neck imaging which showed a decrease in the size of the fluid collection. ## elevated lfts: ruq was unremarkable and her lfts were stable, it was thought to be her recent antifungals. hep b showed immunization, hep c was negative. ## stomal pain/increased stool output: she had an extensive work-up for her stoma pain and high ostomy output last admission, all of which was negative, with no evidence for an active crohn's flare. surgery was consulted but did not feel that an ostomy take down was indicated at this time. pt is under the assumption that she can be considered for take down after her acute medical issues have resolved. gi was following and did not have any further recommendations. -pain regimen includes gabapentin, lidocaine patch, po dilaudid prn. of note, pt reports pain at times despite the regimen. there was concern at one point during her hospitalization that she was tampering with her infusion of iv dilaudid, as they are hung in a minibag and not pushed. she has periods of "stoma" pain with n/v that seem to be cyclical in nature and last for a few days then resolve without intervention. during periods of quiescence she does not require any pain medication. zofran and compazine were given for nausea. pt was started on gabapentin and a lidocaine patch. . ## prior fungemia, staph epidermidis bacteremia: per discharge summary patient was to continue linezolid for 10 days after port removal which was (port removed ) and fluconazole for 14 days after port removal until . she was switched to micafungin through the end of her course given lft abnormalities. courses complete. ## anemia: microcytic, hct within baseline, no brbpr or melena but guaiac + stool at per patient. hct initially 37, but dropped to 23 with hydration which was previous baseline. given 1u prbc transfusion for hct 19 but not actively bleeding at that time. hct was 22.3 on the day of dc. further work up can be pursued in the outpatient setting. ## sinus tach: hr mostly in the 90-110s, which is chronic and likely due to her extensive clot burden. resolved. . #hypercoagulability-recurrent dvt-catheter associated. vasculitis thought to be unlikely given normal anca, , complement levels. medications on admission: enoxaparin 80mg q12h cholecalciferol 1000 units daily loperamide 2mg tid zofran 4mg q8h prn fluconazole 400mg q24h discharge medications: 1. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 21 days: 4 week course. day 1= . last day . 2. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 3. iv heparin iv heparin continuous infusion until inr therapeutic >48hrs. -current rate 1300 units/hr 4. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for flush. 5. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 6. hydromorphone 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for severe pain. 7. psyllium 1.7 g wafer sig: one (1) wafer po bid (2 times a day). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 10. prochlorperazine 25 mg suppository sig: one (1) suppository rectal q12h (every 12 hours) as needed for nausea. 11. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: day 1=. 12. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for pruritis. 14. zofran 4 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. discharge disposition: extended care facility: - discharge diagnosis: superior vena cava syndrome upper extremity deep vein thrombosis enterobacter bacteremia hypercoagulability stoma pain . chronic reported history of crohns. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with worsening abdominal pain and evaluated by surgery and gastroenterology. there were no abnormalities noted, including no evidence of colitis. your pain is thought to be related to your stoma. for this, you should follow up with the surgical team after your current treatment for clot and infection. during the hospitalization you had worsening of your known blood clots and had to have a new catheter placed for iv access. you were started on iv heparin and coumadin and will need to take either coumadin or lovenox at a minimum of 100mg twice a day for life. you also were found to have bacteria in your blood, developing during the hospitalization. you were treated with iv antibiotics and will need to continue this upon discharge for at least 4 week's time. your last day of therapy will be . . medication changes: 1.start coumadin and continue iv heparin 2.start iv meropenem 3.start gabapentin for pain followup instructions: department: hematology/oncology when: friday at 9:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: surgical specialties when: thursday at 10:15 am with: , md building: sc clinical ctr campus: east best parking: garage department: vascular surgery when: thursday at 1:45 pm with: , md building: lm bldg () campus: west best parking: garage department: hematology/oncology when: friday at 9:30 am with: , md, phd building: sc clinical ctr campus: east best parking: garage . interventional radiology-phone: ( . -office phone: ( please call for any questions or issues related to iv access and scheduling upcoming procedures. . please call your pcp for an appointment upon discharge from rehab , r. . please call the infectious diseases department phone: ( for any issues or questions regarding your antibiotic treatment. procedure: angiocardiography of venae cavae central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis anemia of other chronic disease anemia, unspecified hyposmolality and/or hyponatremia hematoma complicating a procedure sepsis hypopotassemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure regional enteritis of unspecified site other specified cardiac dysrhythmias compression of vein other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants disseminated candidiasis other septicemia due to gram-negative organisms personal history of venous thrombosis and embolism diarrhea other and unspecified coagulation defects other specified antibiotics causing adverse effects in therapeutic use ileostomy status other abnormal blood chemistry personal history of pulmonary embolism other colostomy and enterostomy complication acquired absence of intestine (large) (small) bloodstream infection due to central venous catheter tubal ligation status chronic venous embolism and thrombosis of other thoracic veins chronic venous embolism and thrombosis of subclavian veins chronic venous embolism and thrombosis of internal jugular veins other drug-induced pancytopenia 

Answer: The patient is high likely exposed to