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: codeine attending: chief complaint: pneumonia, pancreatic pseudocyst major surgical or invasive procedure: - aborted peg placement - gj tube placement 8/10,14,28,25/09- laparoscopic pancreatic necrosectomy and drainage tube placement history of present illness: pt is a 60 yo f transferred from for management of complicated pancreatitis as well as possible pnuemonia. transferred for worsening respiratory status as well as failure to progress w/ pancreatitis/pseudocyst tx. pt was originally admitted on for gallstone pancreatitis, complicated by infected pseudocyst, pneumonia, ards and persistent fevers. she has failed multiple ercp stent palacements. per osh records, she developed fever to 101.8 and white count of 16.8 today prior to transfer to . her amylase/lipase have normalized. the patient underwent tracheostomy on and was weaned from the vent on , and has been stable on trach mask w/ 10l o2. of note, pt has been treated for vre and cdiff during her extended hospitalization. past medical history: -prior left foot surgery for a heel spur -no other pmh prior to gallstone pancreatitis -as above: ards, pna, gallstones, pancreatitis, pseudocyst, tachy-brady syndrome social history: patient is engaged and her fiancee is her health care proxy. she denies tobacco, etoh, or ivdu. family history: noncontributory. physical exam: vs 96.4 92 104/60 20 100%tm gen: a&o, nad, trached neuro: cn ii-xii grossly intact heent: ncat, anicteric card: rrr -mgr pulm: + ronchi bilat, diffuse crackles abd: soft, ntnd, 3 drains in place draining brown fluid, gj clamped ext: no cyanosis, clubbing, or edema skin: no ulcers pertinent results: 10:51pm alt(sgpt)-18 ast(sgot)-19 ld(ldh)-270* alk phos-170* amylase-31 10:51pm lipase-27 10:51pm albumin-2.0* calcium-8.8 phosphate-3.5 magnesium-2.2 iron-37 10:51pm caltibc-117* ferritin-greater th trf-90* 10:51pm triglycer-78 10:51pm wbc-13.5* rbc-2.82* hgb-8.3* hct-27.7* mcv-98 mch-29.4 mchc-29.9* rdw-15.7* 10:51pm plt count-530* 10:51pm pt-13.4 ptt-24.3 inr(pt)-1.1 11:24pm urine hyaline-* 11:24pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 brief hospital course: briefly, this is a 60f with gallstone pancreatitis with unsuccessful ercp complicated by ards (now s/p trach) and severe pancreatitis resulting in multiple pseudocysts with prolonged, intermittent fevers. was at hospital/ for extended period with vre from pseudocysts, pseudomonas pna and uti (treated with amikacin, details unclear), and c diff treated with oral vanco. was transferred to for futher management and possible cyst gastrectomy. the patient was admitted from osh at the beginning of , expressing suicidal ideation, refusing ventilator, refusing surgery. per psychiatry evaluation, patient having delirium, currently denying suicidal ideation and expressing desire to go ahead with further medical/surgical interventions. over the ensuing days, her affect improved, the suicidal ideation ceased, and she agreed to treatment of her pancreatitis. upon transfer, was thought to be poor candidate for cyst gastrostomy, and has been managed with multiple pseudocyst debridements - or on (placement of two drainage and irrigation systems), (necrosectomy), (necrosectomy), (laparoscopic necrosectomy, 2 l flank drains placed, others not changed, of note there was a concern for a possible enteric fistula based on the nature of the drainge). she was found to have stool leakage and then then underwent a ct scan which revealed a pancreaticocolonic fistula. no small bowel fistula was ever identified on small bowel follow through study. based on this finding, she was made npo and put on tpn, which she needs to continue on until surgical follow up. she also underwent gj tube placement on . the gj is not currently being used and should be clamped until after her follow up visit. as far as her infectious disease course during this hospitalization, pseudocyst cultures have grown heavy pseudomonas and sparse enterococcus. she had a bal with 10-100k oral flora and >100k pseudomonas ( to pip-tazo, tobra, but intermed to meropenem and r to cipro). c diff was negative x 3 but was sent here on oral vancomycin and finished a 14 day course. she was on linezolid/meropenem/oral vanco then changed to linezolid/pip-tazo/tobra (conventional dosing)/oral vanco. based on sensitivities of the pseudomonas and the enterococcus, was then on a course of dapto, zosyn, tobramycin. at that time, adequate drainage was in place after drains placed in or, and remaining positive cultures of drain fluid most likely represented colonization rather than infection, and so once completed over 14 days of antibiotics, they were discontinued on . had a possible vap with rll infiltrate/collapse, bal done and with 2+polys, grew pseudomonas, treated with zosyn and inhaled tobra initially, and then iv tobra, and completed a treatment course on in case of a vap or aspiration pna. antibiotics were then resumed when there was evidence of colonic fistula formation. at the time of discharge, she was on iv ciprofloxacin and iv tobramycin, which she should continue for 2 weeks until surgical follow up. medications on admission: -albuterol/ipratropium -4 puffs tid -ferrous sulfate 325mg daily -lovenox 40mg sc daily same medications on transfer: -guaifenesin 200mg q4hrs prn -tylenol 650mg q6hrs prn -albuterol inh, 4 puffs qhour prn -lactobacillus acidophilis/lactinex -1 tablet daily -miconazole 2% ointment prn -octreotide acetate 100 mcg sc tid -olanzapine 10mg po qhs -protonix 40mg iv bid -vitamin a&d external cream prn -zinc oxide ointment prn discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: four (4) puff inhalation q4h (every 4 hours) as needed for for wheezes. 2. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 3. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: one (1) intravenous q12h (every 12 hours) for 2 weeks. 4. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 5. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours) as needed for secretions. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 7. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). 8. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash. 9. hydromorphone (pf) 1 mg/ml syringe sig: injection q4h (every 4 hours) as needed for pain. 10. phenol 1.4 % aerosol, spray sig: one (1) spray mucous membrane q4h (every 4 hours) as needed for pain. 11. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for pain . 12. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 13. ondansetron 8 mg iv q8h:prn nausea 14. tobramycin sulfate 80 mg/8ml solution sig: 90 mg intravenous every eight (8) hours for 2 weeks. discharge disposition: extended care facility: hospital discharge diagnosis: gallstone pancreatitis, pseudocysts percutaneously, and pneumonia s/p tracheostomy as well as waxing mental status, perc/lap necrosectomy x 4 discharge condition: good, meeting discharge criteria, stable respiratory status with trach mask, npo and chronically on tpn at baseline. discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * take all new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to increase activity daily * no heavy lifting (> lbs) for 6 weeks. * you may shower and wash. no tub baths or swimming. * monitor your incision for signs of infections jp drain care: -please look at the site every day for signs of infection (increased redness, swelling, odor, yellow or bloody discharge, fever). -maintain the bulb deflated to provide adequate suction. -note color, consistency, and amount of fluid in drain. call doctor if amount increases significantly or changes in character. -be sure to empty the drain frequently. -you may shower, wash area gently with warm, soapy water. -maintain the site clean, dry, and intact. -avoid swimming, baths, hot tubs-do not submerge yourself in water. -keep drain attached safely to body to prevent pulling followup instructions: call dr. office at ( to schedule a follow up appointment in 2 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances drainage of pancreatic cyst by catheter drainage of pancreatic cyst by catheter closed [endoscopic] biopsy of bronchus percutaneous [endoscopic] gastrojejunostomy replacement of tracheostomy tube other excision or destruction of lesion or tissue of pancreas or pancreatic duct other excision or destruction of lesion or tissue of pancreas or pancreatic duct injection or infusion of oxazolidinone class of antibiotics other pancreatotomy other pancreatotomy diagnoses: urinary tract infection, site not specified depressive disorder, not elsewhere classified pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonia due to pseudomonas cardiac pacemaker in situ calculus of gallbladder without mention of cholecystitis, without mention of obstruction accidents occurring in other specified places surgical or other procedure not carried out because of patient's decision streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encephalopathy, unspecified chronic pancreatitis acute pancreatitis cyst and pseudocyst of pancreas chronic respiratory failure mechanical complication of tracheostomy feeding difficulties and mismanagement 

Answer: The patient is high likely exposed to