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: fever, abdominal wall infection major surgical or invasive procedure: picc and tunneled hd cath i+d abdominal wound i+d abdominal wall infection i+d abdominal wall abscess ex-lap, gastrostomy closure, umbo hernia, i&d abscess abdominal wall abscess drainage, ir, history of present illness: 48f with chronic hbv, diarrhea and malnutrition of unclear etiology s/p peg placement on , diabetes, admitted to on , now transferred to for multiple medical issues and ?abscess at peg site. per notes, she presented to osh yesterday with 3 days of myalgias, arthralgias, and malaise. she missed hd 2 days pta due to symptoms. she had also been noting elevated sugars at home, initially attributed to newly instituted tube feeds. also noted abdominal pain and nausea to ed providers. labs at osh notable for wbc 31k, hct 25 (from 29 last here) with guaiac positive stools and peg aspirate. initial glucose 752. anion gap 18 with negative urine ketones. positive ua. antibiotics given were vancomycin and timentin. ct was eventually performed which showed a large fluid collection in the left abdomen adjacent to her peg tube that tracks inferiorly. also was written for (?received) 2 units prbcs. she was recently admitted for malnutrition/failure to thrive from to . a dobhoff tube was placed and tube feeds initiated. however, her insurance would not cover home dobhoff services, and thus peg tube was placed on by gi. entecavir was started that admission for chronic hbv infection. she returned for outpatient liver followup - labs at that time notable for wbc 24.2, new hyperbilirubinemia at 4.3. on the floor, patient lethargic and generally poor historian. does not remember exactly when symptoms started or details of what brought her to the ed. denies recent fevers. does seem to endorse left sided abdominal pain, nausea/vomiting, ongoing diarrhea (4-5 times per day), headache, neck pain. ongoing weight loss associated with her poor nutritional status. she is unsure how much insulin she is taking at home. review of systems: (+) per hpi (-) denies fever, chills, cough, shortness of breath, chest pain, chest pressure, palpitations, or weakness. denies constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies rashes or skin changes. past medical history: 1. chronic hepatitis b virus infection - current evaluation for liver transplant at - also with ?autoimmune cholangiopathy, treated with prednisone in past and ?currently 2. end-stage renal disease - secondary to diabetes - being evaluated for renal transplant 3. hypertension 4. diabetes. - complicated by neuropathy, nephropathy, retinopathy. 5. chronic diarrhea/weight loss/malabsorption - no known etiology 6. h/o stroke - residual l-sided weakness most pronounced in leg, hand coordination/strength; uses walker to ambulate 7. s/p peg placement by gi for malnutrition social history: lives with her mother and daughter (15) and son (12). not married. born in but moved to the us in . has been out of work since her stroke and has both vna and home health aide to assist her at home with adls and meds. family history: father died of complications from diabetes. mother also diabetic. otherwise no known illness in family including no known renal/liver disease. physical exam: on admission: general: lethargic, falls asleep easily but very easily arousable. speech slowed and quiet but appropriate. : no obvious facial droop. perrl 3.5->3, eomi. sclera mildly icteric, mmm, oropharynx clear. neck: supple, jvd not elevated, no lad, good rom. lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi; slight decrease at right base. cv: regular rate and rhythm, normal s1 + s2, loud holosystolic murmur heard throughout precordium. abdomen: peg site in luq. small amount of dried blood at exit site but no purulent drainage noted. mostly clear bilious fluid from peg. no surrounding erythema. + moderate ttp in l side of abdomen with guarding, no clear rebound. + ttp in r abdomen as well but seems to be bothering her more in l side with r sided palpation. +tender with shaking bed. bowel sounds present. ext: warm, well perfused, + edema equal bilaterally. tunnelled r hd line looks benign. stage ii decub on buttocks. neuro: mental status as above. cn ii-xii intact. strength 5/5 in all rue and rle muscle groups. 4-/5 at l plantar and dorsiflexors. intrinsic hand muscles. 4+/5 in elbow flexors and extensors. on discharge: tm=100.4, tc=97.5, hr=70s-100s, bp=130s-160s/70s-100s, rr=18, pox=99% ra blood sugars: 80s-130s 8hr i/os: 585cc tpn / 0 24hr i/os: 720cc po + 1952cc tpn / bmx1 general - nad, depressed - perrl, eomi, sclerae icteric with subungual icterus neck - supple, no jvd lungs - coarse bs bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, loud holosystolic murmur heard throughout precordium, nl s1-s2 abdomen - + bs, wound vac in place over recent i&d site. diffuse, but mild ttp extremities - wwp, + edema bilaterally with fluid concentrated in feet/ankles, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - a&ox3 pertinent results: labs on admission: 10:10am pt-14.2* ptt-28.3 inr(pt)-1.2* 10:10am plt count-482* 10:10am hypochrom-3+ anisocyt-2+ poikilocy-occasional macrocyt-occasional microcyt-2+ polychrom-normal target-2+ 10:10am neuts-86.5* lymphs-10.0* monos-2.8 eos-0.3 basos-0.3 10:10am wbc-26.7* rbc-4.11* hgb-9.4* hct-30.8* mcv-75* mch-22.8*# mchc-30.4*# rdw-19.3* 10:10am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 10:10am vanco-16.1 10:10am acetone-negative 10:10am albumin-2.2* calcium-8.6 phosphate-4.1 magnesium-2.5 10:10am lipase-18 10:10am alt(sgpt)-28 ast(sgot)-73* ld(ldh)-226 alk phos-421* tot bili-5.5* 10:10am estgfr-using this 10:10am glucose-373* urea n-73* creat-4.3* sodium-134 potassium-5.1 chloride-90* total co2-28 anion gap-21* labs on discharge: wbc rbc hgb hct mcv mch mchc rdw plt ct 19.3* 3.25* 8.9* 29.4* 91 27.5 30.4* 20.9* 604* neuts bands lymphs monos eos baso 88.6* 0 7.5* 3.1 0.5 0.2 pt ptt inr(pt) 13.41 34.8 1.1 glucose urean creat na k cl hco3 angap 75 74* 3.0* 140 4.7 103 23 19 alt ast ld(ldh) alkphos totbili 36 96* 262* 552* 7.5* albumin calcium phos mg 2.5* 9.1 2.2*# 2.2 microbiology: stool studies: - cdiff: negative x 10 (last negative ) - positive stool afb (non-tuberculosis/mac afb) : state lab pending final speciation - microsporidia stain (final ): no microsporidium seen. - cyclospora stain (final ): no cyclospora seen. - ova + parasites (, , , ): no ova and parasites seen. - cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. blood cx: - blood culture : positive for (torulopsis) glabrata blood culture, routine (final ): escherichia coli. final sensitivities. pseudomonas aeruginosa. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | pseudomonas aeruginosa | | amikacin-------------- 16 s ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s 16 i ceftazidime----------- <=1 s 8 s ceftriaxone----------- <=1 s ciprofloxacin--------- 2 i =>4 r gentamicin------------ <=1 s =>16 r meropenem-------------<=0.25 s 4 s piperacillin/tazo----- <=4 s =>128 r tobramycin------------ <=1 s =>16 r trimethoprim/sulfa---- <=1 s blood cultures negative x26 (last blood culture was negative) - abscess culture : mixed bacterial types gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive rod(s). 4+ (>10 per 1000x field): gram negative rod(s). 3+ (5-10 per 1000x field): budding yeast. wound culture (final ): mixed bacterial types (>= 3 colony morphologies) isolated. pseudomonas aeruginosa. >15 colonies. escherichia coli. >15 colonies. stenotrophomonas (xanthomonas) maltophilia. <15 colonies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | escherichia coli | | stenotrophomonas (xanthomon | | | amikacin-------------- 8 s ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- 8 s <=1 s ceftazidime----------- 8 s <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r 1 s gentamicin------------ =>16 r <=1 s meropenem------------- 4 s <=0.25 s piperacillin/tazo----- =>128 r <=4 s tobramycin------------ =>16 r <=1 s trimethoprim/sulfa---- <=1 s <=0.5 s - hiv pcr: non-detected , hbv viral load (final ): hbv dna detected, less than 40 iu/ml. hbv viral load (final ): 192 iu/ml. sputum: acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): wound: wound culture (final ): enterococcus sp.. sparse growth. sensitivities requested per dr. # . (torulopsis) glabrata. sparse growth. identification requested by dr.. sent to for sensitivities to fluconozole. refer to sendout system for results. lactobacillus species. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r linezolid------------- 1 s penicillin g---------- =>64 r vancomycin------------ =>32 r studies: ct-guided drainage of abscess : impression: technically successful aspiration and insertion of drainage catheter into left anterior abdominal abscess. post-procedure orders were entered into provider order entry system. sample sent for microbiology studies. ct abdomen/pelvis with contrast : impression: 1. large anterior abdominal air and fluid collection with peripheral enhancement status post drainage catheter placement is minimally decreased in ap diameter in the superior portion; however, the inferior portion cannot be compared to prior study as it was not included in the field of imaging. catheter is in appropriate position. 2. small amount of heterogeneous and hyperdense material adjacent to the inferior aspect of the liver may represent small amount of blood clot. please correlate with recent intervention at this location. 3. extensive anasarca and intra-abdominal and pelvic ascites. g-tube check : findings: a percutaneous gastrostomy has been placed. contrast outlines the lumen of the stomach and rugal folds. no extravasation of contrast outside the tube or the stomach is identified. also noted is a pigtail catheter entering from the left side of the abdomen. transthoracic echocardiogram : the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is mildly depressed (lvef= 40-45 %). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. ascites is present. impression: normal cavity size with mild global left ventricular hypokinesis c/w diffuse process (toxin, metabolic, etc.) mild mitral regurgitation with normal valve morphology. aortic valve sclerosis. ascites. ct-guided evaluation of drain : impression: 1. free communication of anterior abdominal wall abscess with the stomach via the patient's g-tube tract. 2. the anterior abdominal wall is stable in appearance and likely comprises a combination of gas from the stomach and extensive phlegmon. the pre-existing pigtail catheter is in appropriate location. unsuccessful attempted placement of the second inferior pigtail catheter as this area was not in fact a fluid collection, but instead inflammatory phlegmonous tissue. temporary hd line placement, rij : report pending nasointestinal tube placement : impression: nasointestinal feeding tube positioned within the stomach. unable to advance into a post-pyloric position. recommend followup kub to assess for advancement via peristalsis. preoperative cxr pa/lateral : chest, frontal and lateral views: the lungs are clear. the right hemidiaphragm is elevated. heart size, mediastinal and hilar contours are normal. there is no effusion, consolidation or evidence of pulmonary edema. right central venous catheter terminates in the expected location of the superior vena cava. nasogastric tube terminates below the stomach, with the tip in the left upper quadrant directed cephalad. the peg balloon projects over the stomach. impression: no acute cardiopulmonary abnormality ct-abd/pelvis impression: 1. status post debridement of left anterior abdominal air and fluid collection. gas and fluid persists in the left abdominal wall but has reduced since prior study, with a small residual fluid-containeng component at the left inguinal region. 2. persistent but lessened moderate ascites 3. extensive third space fluid. 4. progressed appearance of airspace opacification at bases (right greater than left), compatible with aspiration and/or infection. 5. persistent extensive vascular calcifications. 6. multifocal areas of colonic wall thickening compatible with resolving colitis. ct-abd/pelvis impression: 1. no evidence of intra-abdominal or pelvic abscess. 2. ascites and widespread peritoneal, pelvic and omental nodularity, similar to that seen previously. it is unclear if this is reactive or neoplastic. if indicated, peritoneal fluid cytology could be considered. 3. cholelithiasis. 4. dobbhoff tube terminating in the proximal stomach. the tube could be advanced by 5-10 cm. 5. increasing bibasilar pulmonary consolidations. 6. heterogeneous splenic attenuation. given the atherosclerosis, this may be related to abnormal perfusion timing. attention to this area is recommended on follow-up imaging. 7. extensive atherosclerotic disease. ruq u/s impression: 1. diffuse echogenicity of the liver, most likely in keeping with fatty infiltration. 2. small amount of ascites. 3. severely thickened gallbladder wall, secondary to the patient's hypoalbuminemia. 4. no evidence of filling defects within the biliary tree. cxr pa/lat right picc tip is in the upper svc. right ij hemodialysis catheter is in standard position. there are low lung volumes. mild cardiomegaly is stable. right lower lobe atelectasis is more conspicuous from prior. there is no pneumothorax or pleural effusion. ct-chest impression: 1. no evidence of chronic or active tuberculosis. 2. no pnuemonia. no intrathoracic lymphadenopathy. mild bibasilar atelectasis. chronic rll subsegmental atelectasis. 3. persistent moderate-sized simple ascites. 4. simple cholelithiasis. brief hospital course: 48f with h/o hep b, dm, chronic diarrhea, malnutrition s/p recent peg placement, who presented with abdominal pain and malaise, found to have an abdominal wall abscess, now s/p ex-lap and extensive debridement. her hospital course has been complicated by e.coli, , and pseudomonas bacteremia and increased diarrhea likely secondary to a mycobacterial gi infection. #. abdominal wall abscess: the patient initially presented with fatigue and was found to have dka at an osh. given concern for abdominal fullness on physical exam, she had a ct-abdomen, which showed evidence of an abdominal abscess around the site of her peg tube, which was placed on . she was then transferred to on , given the fact that her peg tube was placed here. this fluid collection was drained by ir on and demonstrated . blood cultures from admission also demonstrated candidemia. on , the patient underwent an ex-lap for debridement and limited gastric resection. her hospital course has been complicated by extensive abdominal wall debridement requiring i&d by surgery: i+d abdominal wound, i+d abdominal wall infection, and i+d abdominal wall abscess. she has completed multiple courses of antibiotics including linezolid discontinued on after a 24 day course, fluconazole discontinued on after a 23 day course and completed meropenem day on for pseudomonas, enterococcus, e. coli and infection. the patient's abdominal wound has a wound-vac placed by plastic surgery. the plan is to continue the wound-vac at rehab and will follow-up with dr. in outpatient clinic for closure options. additionally, she will continue tpn in hopes of improving her nutritional status for appropriate wound healing for closure. the patient should continue the wound-vac and follow-up with dr. in plastic surgery clinic in the next 1-2 weeks. dr. office is aware of the patient and will call the rehab with a follow-up appointment. . #. diarrhea: the patient has a history of diarrhea, s/p extensive outpatient workup. she is currently being seen by gastroenterology and has known pancreatic insufficiency on creon. ttg iga is negative for celiac disease, and she was previously found to have low stool elastase and positive fecal fat, concerning for malabsorption. the patient had a colonoscopy and biopsy from with no diagnostic abnormalities. the patient's diarrhea improved after her tf were discontinued on . she was initiated on tpn for nutrition with minimal po intake. she has had multiple stool c. diff and cultures that have returned negative. however, stool study from came back positive for afb that was shown not to be tuberculosis or mac. a ct chest with contrast was negative for any signs of active or chronic tuberculosis and respiratory isolation precautions were discontinued per id recommendations . hiv viral load has been negative as well. the state lab is attempting to speciate the type of mycobacterium via dna probes and may take up to 6 weeks. the afb in her stools could be a cause of her chonic diarrhea, but treat is not being pursued until final speciation has been made. additionally, her diarrhea has improved with tincture of opium, loperamide and creon. she has been having bm per day, that is at her baseline. the afb cultures from the state lab should be followed-up. # chronic hep b infection/autoimmune cholangiopathy. the patient remains jaundiced on physical exam and her lfts have been fluctuating likely secondary to a combination of her chronic liver diseases, blood transfusions, and tpn. her alkaline phosphatase peaked at 1313 and her ast peaked at 104 on . her total bilirubin peaked at 8.5 . ruq u/s read indicates irregular contour and heterogeneity of the liver suggestive of chronic liver disease with a small amount of ascites. her albumin has been slowly increasing with tpn to 2.5 she is being continued on entecavir/tenofovir and hb viral levels were 192 on , but were undetectable on . she was started on ursodiol 250mg tid on . her bilirubin began trending up again . her prednisone was increased to 15mg daily and her bilirubin began to decrease 7.5 at the time of discharge. the plan is to continue 15mg prednisone for 7 days (started on ). then tapering to 10mg daily for 7 days (initiate on ) and then again tapering to 5mg daily. she should continue 5mg prednisone daily, after her taper until she follows-up with liver clinic. # bacteremia: the patient was found to have in her blood on . her blood cultures also grew pseudomonas and e.coli on . the patient was closely followed by infectious disease. she has completed multiple courses of antibiotics including linezolid discontinued on after a 24 day course, fluconazole discontinued on after a 23 day course and completed a 10 day course of meropenem on . likely source is her intra-abdominal infection. she is hemodynamically stable and afebrile. the patient should have ophtho follow-up in 2 weeks given her candidemia or sooner if she develops vision symptoms. the patient's last positive blood cultures were from and have remained negative since (last negative culture ). the patient with persistent leukocytosis during her hospitalization ranging between 15-20k. # hyperglycemia/dm. per the patient's pcp she has uncontrolled type ii diabetes. the patient was followed by diabetes during her hospitalization. her current regimen is 8u lantus qhs and humolog ss. # esrd. the patient receives hd m/w/f at via r tunnelled line. she was maintained on her hd scheduled and followed by the renal team. given the patient's bacteremia and fungemia her previous tunnelled line was removed on . her temp dialysis line was again removed and grew pseudomonas, e. coli, and stenotrophomonas. a new right ij tunnelled hd line was placed on . the patient's last hd session was on . # anemia: during her hospital course she has received a total of 6u prbc. her last transfusion was on and her hct has remained stable (32-28). her anemia is likely secondary to anemia of chronic disease/inflammation and chronic kidney disease. she has been receiving procrit at hd sessions per renal. # hypertension. the patient has known hypertension. her lisionpril and metoprolol were titrated during her hospitalization. she was discahrged on lisinopril 20mg daily and metoprolol 25mg . her bp medications should be held until after dialysis per renal in order to minimize hypotension in hd. # fen: see above regarding diarrhea. the patient was started on tpn on and should continue tpn at rehab. she has been taking minimal po intake as well. medications on admission: - entecavir 1 mg once a week: fridays after hemodialysis. - oxycodone 5 mg: every 4-6 hours as needed for pain * - b complex-vitamin c-folic acid 1 mg daily * - folic acid 1 mg daily * - lisinopril 20 mg daily * - megestrol 400 mg/10 ml: ten ml q12h as needed for poor po intake. - loperamide 2 mg q4h as needed for diarrhea. * - tincture of opium 10 gtts qid * - metoprolol succinate 50 mg daily (or 25 mg daily) * - ursodiol 300 mg - multivitamin daily * - nexium 40 mg daily * - tenofovir 300 mg 1x/week (fr) - prochlorperazine 10 mg once a day as needed for nausea. * - ferrous sulfate 325 mg tid (or daily) * - ascorbic acid 500 mg tid please give with iron. - gabapentin 300 mg daily - prednisone 5 mg tablet daily - insulin regular according to sliding scale - insulin glargine fifteen units subcutaneous at bedtime. (or 30 per osh notes) * - ?klor-con 20 discharge medications: 1. glucagon (human recombinant) 1 mg recon soln sig: one (1) mg injection q15min () as needed for hypoglycemia protocol. mg 2. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po 1x/week (fr). 3. entecavir 0.5 mg tablet sig: two (2) tablet po 1x/week (fr). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal tid (3 times a day) as needed for rectal pain. 8. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection (2 times a day). 9. loperamide 2 mg capsule sig: one (1) capsule po q1h (every hour) as needed for diarrhea. 10. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily): please hold prior to hd, can administer after hd, hold for sbp<100 . 11. opium tincture 10 mg/ml tincture sig: ten (10) drop po q4h (every 4 hours) as needed for diarrhea: please administer to patient 1-2 hours prior to taking po . 12. ursodiol 250 mg tablet sig: one (1) tablet po tid (3 times a day). 13. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: four (4) cap po tid w/meals (3 times a day with meals): please give 1 capsule before, 2 capsule during, and 1 capsule after meals and snacks. . 14. lorazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety, dizziness, nausea. 15. mirtazapine 15 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po hs (at bedtime). 16. prednisone 5 mg tablet sig: three (3) tablet po qd () for 4 days: last dose 3/22. 17. prednisone 10 mg tablet sig: one (1) tablet po qd () for 7 days: starting . 18. prednisone 5 mg tablet sig: one (1) tablet po qd () as needed for autoimmune cholangitis: starting on . 19. medium chain triglycerides 7.7 kcal/ml oil sig: fifteen (15) ml po tid (3 times a day). 20. dextrose 50% in water (d50w) syringe sig: 12.5 grams intravenous prn (as needed) as needed for hypoglycemia protocol. 21. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea. 22. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 23. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 24. hydromorphone (pf) 1 mg/ml syringe sig: 0.5 mg injection q6h (every 6 hours) as needed for breakthrough pain. 25. lantus 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. 26. insulin lispro 100 unit/ml solution sig: as directed subcutaneous four times a day: refer to attached sliding scale. discharge disposition: extended care facility: & rehab center - discharge diagnosis: intrabdominal abscess, bacteremia, fungemia, pancreatic insufficiency, malnutrition . secondary diagnoses: -chronic hepatitis b infection -autoimmune cholangiopathy -esrd on hd m/w/f -htn -diabetes -h/o cva -chronic diarrhea discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to hospital for evaluation of fatigue and were found to have diabetic ketoacidosis as a result of an abdominal abscess/infection around the site of your peg tube. the fluid inside the abscess was drained and grew out several multi drug resistant bacteria and yeast. this bacteria also entered your blood stream and required a long course of treatment with several powerful antibiotics and antifungals. you also needed additional surgeries to clean out the infection and abscess which led to your open abdominal wound requiring a wound vac. you were also having profuse diarrhea following food intake and were malnourished. therefore tpn or iv nutrition was started along with normal food intake. . several changes were made to your home medication regimen which will be passed along to your rehab facility. . please follow-up with all of your outpatient medical appointments listed below. followup instructions: please follow-up at the following appointments listed below: . you will be contact by our plastic surgery office at for follow up regarding your wound and also regarding the vac. please contact the office at to schedule a follow up appointment with dr. if you do not hear from them. ophthomology appointment: eye clinic: at 9:30am floor 5 . 1. provider: , md phone: date/time: 8:40 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous abdominal drainage excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn closed [endoscopic] biopsy of large intestine other open umbilical herniorrhaphy closure of gastrostomy diagnoses: end stage renal disease renal dialysis status anemia, unspecified other postoperative infection sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia disseminated candidiasis chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta peritoneal abscess other specified diseases of pancreas umbilical hernia without mention of obstruction or gangrene pseudomonas infection in conditions classified elsewhere and of unspecified site mechanical complication of gastrostomy other severe protein-calorie malnutrition diabetes with renal manifestations, type ii or unspecified type, uncontrolled necrotizing fasciitis 

Answer: The patient is high likely exposed to