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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain major surgical or invasive procedure: exploratory laparotomy, small bowel resection bedside debridement with opening of abdominal wound, placement of vac history of present illness: history based on night float admission note obtained w/ aid of an interpreter and electronic medical records. in brief, 59 yof s/p colectomy w/ ileostomy for recurrent colorectal cancer who represented am to ed for lower abdominal pain and found to have uti. pt was started on cipro and went back to rehab with foley in place. however, then decided she did not want to stay at rehab and returned to ed. at that time c/o sscp radiating to back. in the ed, cta negative for pe or aortic dissection. ecg w/ no ischemic changes and unchanged from old ekg . biomarkers negative x 1 in ed. she described the pain as sharp, burning quality, radiating to back, w/ no associated sob, diaphoresis. + nausea but no vomiting. worse laying down. improved sitting up. not related to exertion but she does not exert herself much at baseline. pain lasted ~24 hours. she has never had this pain before. overnight, her chest pain was treated with protonix and maalox. the following morning on this admission, she continued to complain of mild chest pain. no other localizing complaints currently. she was intially admitted to the medicine service and later transfered to the colorectal surgical service for furthur care. past medical history: # rectal ca s/p age 29 # recurrent adenocarcinoma of transverse colon s/p colectomy/ileostomy # urinary retention s/p foley placement prior admission social history: chinese speaking only. immigrated 2 years ago with help of mother and brother. does not speak to either at this time. married with husband and son in . shares a rented room with a friend. full-time as a home health aide. non-smoker, no alcohol use. does have a friend and two cousins in town who are willing to provide health but patient does not want her medical condition shared with them. family history: no family history of colon cancer. physical exam: pe: 99.5, 110/58, 75, 20, 100% 2lnc gen: nad heent: nc/at. eomi. peerl. mmm neck: low jvp heart: rrr no mrg lungs: ctab abd: soft, nt, nd. ileostomy stoma c/d/i w/ brown stool. ext: wwp. no cce. pertinent results: cxr: new free intraperitoneal air consistent with patient's history of recent colectomy. similar appearance of scarring and calcifications in the right upper lobe. otherwise, no cause for patient's symptoms identified. . cta: 1. no evidence of pulmonary embolism or aortic dissection. 2. prominent lymph nodes in the right axilla, unchanged since . 3. granulomatous changes in the right upper lobe. 4. free air and other post-surgical changes seen in the abdomen. 02:50pm blood wbc-5.5 rbc-3.42* hgb-10.2* hct-29.8* mcv-87 mch-29.7 mchc-34.1 rdw-12.7 plt ct-240# 06:07am blood wbc-6.1 rbc-3.20* hgb-9.4* hct-28.2* mcv-88 mch-29.3 mchc-33.3 rdw-13.0 plt ct-208 02:50pm blood glucose-128* urean-14 creat-0.5 na-137 k-3.3 cl-104 hco3-24 angap-12 06:07am blood glucose-92 urean-9 creat-0.6 na-140 k-4.0 cl-109* hco3-24 angap-11 09:30pm blood ck(cpk)-51 06:07am blood ck(cpk)-45 09:30pm blood ctropnt-<0.01 06:07am blood ck-mb-notdone ctropnt-<0.01 06:07am blood calcium-9.0 phos-3.7 mg-2.0 iron-pnd gallbladder ultraound : impression: 1. normal liver with no focal lesion. 2. gallbladder sludge with no evidence of cholecystitis. 3. small amount of free fluid is noted within the abdomen. . abdominal and pelvic ct scan : impression: extensive small bowel obstruction, which has progressed since prior study performed eight hours before associated with edema of the right ileostomy. anterior wall air fluid collection where the colostomy was located. pneumoperitoneum. . cardiology report ecg study date of 9:02:08 am sinus rhythm normal ecg since previous tracing of the same date, no significant change . ct scan : impression: 1. interval increase in small bowel dilatation seen previously, with resolution of bowel wall thickening seen previously. this could reflect obstruction at the ileostomy, vs. ileus - clinical correlation is required. there is no evidence of ischemia. 2. continued third spacing of fluid, with bilateral pleural effusions, slightly decreased ascites, and soft tissue anasarca. . angiogram : impression: selective sma and ileocolic angiograms demonstrate mild peristomal hypervascularity, however, no active extravasation. no embolization performed. if the patient rebleeds, a tagged rbc scan may help to localize the bleeding prior to any repeat angiogram. . abdominal x-ray : impression: distended loops of gas filled small bowel extending to ileostomy with multiple scattered air-fluid levels. this may represent ileus, however obstruction at the ileostomy as mentioned on prior ct cannot be entirely excluded. recommend clinical correlation. . discharge labs: 01:41pm blood hct-26.9* 04:17am blood plt ct-324 06:00am blood glucose-99 urean-12 creat-0.3* na-135 k-4.1 cl-105 hco3-26 angap-8 06:00am blood calcium-8.1* phos-3.6 mg-2.0 04:17am blood caltibc-182* ferritn-973* trf-140* 04:17am blood triglyc-134 01:05am blood triglyc-171* hdl-13 chol/hd-6.4 ldlcalc-36 . 8:36 am swab source: abdominal midline wound. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): gram negative rod(s). wound culture (final ): enterococcus sp.. sparse growth. sensititities per dr () . klebsiella pneumoniae. rare growth. trimethoprim/sulfa sensitivity testing available on request. yeast. rare growth. sensitivities: mic expressed in mcg/ml _____________________________________________________ enterococcus sp. | klebsiella pneumoniae | | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 2 s ciprofloxacin--------- <=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s linezolid------------- 2 s meropenem------------- <=0.25 s penicillin------------ =>64 r piperacillin/tazo----- <=4 s tobramycin------------ <=1 s vancomycin------------ =>32 r . 3:31 am urine source: catheter. urine culture (final ): yeast. ~6ooo/ml. probable enterococcus. ~6ooo/ml. . 9:48 pm urine source: catheter. urine culture (final ): no growth. . 8:39 am mrsa screen source: rectal swab. . mrsa screen (final ): no mrsa isolated. brief hospital course: 59 year oold female with history of recurrent colorectal cancer s/p colectomy and ileostomy approx 10 days prior to this admission, and recently diagnosed uti, presents with complaints of substernal chest pain. the patient was initially admitted to the medicine service and then transfered to the surgical service for furthur care. during this patient's admission, her issues have been as follows: . chest pain/cardiac: on admission, the patient presented with atypical cp. this was thought to be most likely costochondritis given reproducibility with palpation of chest wall. gerd also considered. chest pain resolved with proton pump inhibitor. no evidence of ischemia on ekg or cardiac enzymes. there was no evidence of pe or dissection on cta on imaging. post-operatively, the patient's chest pain had resolved but she remained tachycardic at baseline. she "triggered" for tachycardia to the 140-150's. on discharge, her hr ranged from the 90-110's. she denied chest pain on discharge. . neuro: alert and oriented to time, place, and person throughout entire hospitalization. cantonese speaking only, daily plan of care communicated via interpreter. . gi: on hospital day #2, patient developed severe diffuse abdominal pain. abdominal labs revealed only mild elevation in ast/alt. kub showed some dilated loops of bowel but was otherwise unremarkable. a ct scan of the abdomen showed a small bowel obstruction. an ng tube was placed, patient was made npo with intravenous hydration. the patient was then transferred to the surgical service. on hd 5, ngt removed, ostomy with air and stool, liver function tests without elevation, gallbladder ultrasound without evidence of cholecystitis. on diet advanced hd 6, tolerating a regular soft diet, ostomy functioning well. on pod 12/hd 8, she had an episode of tachycardia and increased abdominal pain, she was made npo with intravenous hydration, nasogastric tube was placed, ct scan demonstrated a worsening small bowel obstruction, her stoma was necrotic appearing, she was transferred to the icu for close monitoring, placement of a central line, intravenous antibiotics and aggressive fluid resuscitation; she was then taken back to the or and underwent an a lysis of adhesions, resection of her terminal ileum, and revision of her ileostomy without complication. pod 15/hd 11, tpn was started, ostomy had +flatus, diuresis with lasix was initiated, she remained hemodynamically stable. hd 13/pod 4, she was extubated without difficulty, ostomy with loose output, volume replaced with intravenous fluid and imodium started. pod 20/hd 16, she was transferred to an in-patient nursing unit, central line was removed, tpn was stopped, and her diet was advanced however poor oral intake with significant malnutrition, dobbhoff placed and trophic tube feeds started along with replacement of central line and tpn. repeat ct scan without evidence of ischemia and resolution or small bowel thickening. . chest: oxygenating well on room air. encouraged is use on a regular basis. . colorectal cancer: s/p recent colectomy . . uti: urine culture from grew klebsiella sensitive to cipro. she completed seven day course of cipro. repeat urinalysis and culture without bacteria. . urinary retention: post-op urinary retention during recent admission . her foley was removed but then replaced in the setting of sbo, failed four voiding trial with successful removal of foley and ability to void without difficulty on pod 40/27 with the addition of ditropan. . fen: inability to maintain optimal caloric intake with po diet and evidence of malnutrition demonstrated by nutrition labs, dobbhoff feeding tube placed with trophic tube feeds and tpn, intermittent episodes of npo during episodes of gi bleeding, once hematocrit stabilized and no further bleeding demonstrated, diet was slowly advanced. tolerating minimal amounts of regular diet at time of discharge with goal rate of trophic tube feeds and half strength tpn. nutrition requirements to be followed closely at rehabilitation facility with goal of weaning both tube feeds and tpn once caloric oral intake increased. . ppx: ppi. sqh. bowel regimen. pneumatic boots. . id: +vre, mrsa negative, repeat urine culture negative, hd 19, incision with erythema, opened at bedside with copious amounts of purulent drainage, cultures sent,+vre, klebsiella, and trace yeast, linezolid started along with zosyn and caspofungin. wound vac placed. leukocytosis to 16k with improvement to 10k after initiation of antibiotics. antibiotics stopped on pod 37/24, remained afebrile without leukocytosis. wound vac continued with every day dressing change with overall improvement in abdominal wound; pink granulation tissue present without erythema or induration. left subclavian central line in place at time of discharge for tpn, to be removed once tpn discontinued. no antibiotics necessary at time of discharge. white count normal. . heme: pod 34/21 ostomy with frank bleeding, hematocrit dropped to 16, transfused prbc's to maintain hematocrit > 24 and transferred to sicu for close monitoring, remained normotensive with baseline tachycardia 100's; angiogram without source of bleeding identified, gi consulted; egd done without evidence of bleeding, erosion in the distal small bowel seen and area close to ileostomy with edema. treated with octreotide drip during acute blood loss episodes and prbc transfusions; hematocrit stabilized pod 37/24, she remained hemodynamically stable, bowel prep of mag citrate given without bleeding and stool guaiac negative. remained hemodynamically stable with a hematocrit of 26.9 at time of discharge. . pain: pain was initially well controlled with intravenous dilaudid, once she started taking po's was transitioned to oral dilaudid; narcotic tolerance had increased over course of prolonged hospitalization, oxycontin started with oral dilaudid for breakthrough pain along with intravenous dilaudid during dressing changes at time of discharge. she will require continued narcotics at rehab and weaning as tolerated. . msk: followed by physical therapy throughout hospitalization with gradual improvement in ambulation. recommend transfer to rehab for continued therapy to increase gait, strength, and functional mobility. at time of discharge, the patient was ambulating with assistance but will require furthur physical therapy. medications on admission: percocet protonix colace discharge medications: 1. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 3. hydromorphone 2 mg tablet sig: 1-2 tablets po q3-4h (every 3 to 4 hours) as needed for pain: hold for sedation, confusion, or rr < 12. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 6. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. hydromorphone 2 mg/ml syringe sig: 0.5 ml injection every six (6) hours as needed for breakthrough pain: dose should equal 1 mg to be used for severe pain only after oral medication has been given . 8. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed: to eachl lumen of cvl. 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day): until ambulating independently, then d/c. 10. remove cvl sig: remove left subclavian line once: remove cvl on when tpn has finished. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: small bowel obstruction necrotic bowel wound infection malnutrition secondary: 1. colorectal cancer 2. urinary retention 3. uti discharge condition: stable discharge instructions: please call your doctor or return to the emergency department if you experience, increased or persistent pain not relieved by pain medication, fever > 101.5, nausea, vomiting, or abdominal distention, increased or decreased ostomy outputs over 24 hours, change in color or appearance of stoma, inability to urinate after foley removed, if abdominal wound develops redness or drainage, shortness of breath or chest pain, any other symptoms concerning to you. . continue a regular diet. continue tube feeds. engage in physical exercise. followup instructions: follow-up with dr. in weeks, building . call for an appointment. follow-up with your pcp, . upon discharge from rehabilitation facility, call for an appointment. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other partial resection of small intestine other endoscopy of small intestine other endoscopy of small intestine enteral infusion of concentrated nutritional substances other lysis of peritoneal adhesions revision of stoma of small intestine nonexcisional debridement of wound, infection or burn transfusion of packed cells other immobilization, pressure, and attention to wound injection or infusion of oxazolidinone class of antibiotics diagnoses: other postoperative infection urinary tract infection, site not specified unspecified protein-calorie malnutrition paralytic ileus retention of urine, unspecified iron deficiency anemia, unspecified hemorrhage of gastrointestinal tract, unspecified chest pain, unspecified tachycardia, unspecified intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) unspecified vascular insufficiency of intestine personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus other colostomy and enterostomy complication 

Answer: The patient is high likely exposed to