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: history of present illness: briefly, this is a 67 year old female who presented to an outside hospital with abdominal pain, distention, nausea, for approximately three days. her last bowel movement was approximately the day prior to her admission which was in . she had had a history of small bowel obstructions and had felt these symptoms in previous episodes. of note, the patient had a history of a gastric bypass performed several years ago as well as an incarcerated hernia repair. the patient was admitted to an outside hospital and ultimately underwent an exploratory laparotomy and repair of hernia and was being taken care of at the outside hospital. however, during her hospital course there, she was found to have serous drainage from her wound and was found to have developed a significant enterocutaneous fistula. therefore, it was decided at the outside hospital that she would be transferred to for further management by dr. . past medical history: 1. hypothyroidism. 2. pancreatitis. 3. asthma. 4. history of pneumonia. 5. history of varicose veins. 6. history of small bowel obstructions in the past. past surgical history: 1. gastric bypass approximately fifteen years ago. 2. cholecystectomy. 3. exploratory laparotomy and lysis of adhesions times two for small bowel obstruction. 4. breast reduction surgery. 5. several ventral hernia repairs. allergies: penicillin and iodine. medications on transfer: 1. octreotide. 2. fentanyl patch. 3. levaquin. 4. flagyl. 5. dilaudid pca. 6. lopressor. 7. vancomycin. 8. atrovent nebulizers. 9. tpn. she also had a picc line which was placed at the outside hospital and was having wet to dry dressing changes to her abdominal wound. a g-j tube had been placed during her operation at the outside hospital and those were kept on intermittent suction. she also had - drain which was also to bulb suction. physical examination: on admission to , the patient was afebrile and her vital signs were stable. she was an obese female in no apparent distress. she was saturating 98% on two liters nasal cannula. her lungs had some mild crackles but were clear. her heart was regular. her abdomen was obese, nontender, and she had an open enterocutaneous fistula times three and open surgical wound on her belly with retention sutures in place and foley catheter was also in place. her extremities were severely edematous which stated by her was her baseline. laboratory data: the patient's laboratories are all within normal limits. hospital course: the patient was admitted to the blue surgery service and was continued on tpn for preoperative nutritional enhancement and it was planned the patient would ultimately undergo exploratory laparotomy and repair of the enterocutaneous fistula. on , the patient was taken t the operating room for an attempted revision of her multiple enterocutaneous fistulas. the patient did well from the operation, however, postoperatively she developed single enterocutaneous fistula which caused wound breakdown and again she was started on tube feeding as well as tpn for nutritional enhancement. the enterocutaneous fistula was not able to be closed with just nutritional enhancement. therefore, it was decided that the patient would have to return to the operating room on , for a reexploration and component separation and flap closure, split thickness skin graft closure for this enterocutaneous fistula. dr. , the plastic surgery service, was consulted for this workup and followed this patient along throughout her entire hospital course. the patient was taken to the operating room on , where closure of her enterocutaneous fistula was done and split thickness skin graft was also performed as well as a revision of her g-j tube. postoperatively, the patient was transferred to the intensive care unit for blood pressure support and prolonged ventilatory support. the patient was slowly weaned from the ventilator postoperatively, however, after extubation, she had significant respiratory distress and required significant fluid management. therefore, she was reintubated and continued in the intensive care unit. again, she required prolonged pressor support for her blood pressure and fluid management. she slowly improved from a pulmonary standpoint after the second intubation and she was able to be diuresed gently from her fluid. she was started on tpn and she was successfully able to be weaned from the ventilator postoperatively. the patient also had episodes of temperature spikes and was found to have gram positive cocci in blood cultures as well as on line cultures. therefore, she was started on broad spectrum antibiotics. she was continued on multiple antibiotics and ultimately completed a twenty-two day course of zosyn for the positive blood cultures and for her line sepsis. she continued to improve slowly in her intensive care unit stay and her bowel function slowly returned. her tube feeds were slowly advanced through this time frame which she was able to tolerate. she was extubated on , and was able to tolerate for a day, however, she had an episode of bradycardia and asystole on , requiring emergent intubation. she responded to epinephrine and returned to sinus rhythm with her blood pressure returning to greater than 200. it was noted that the patient had increased distention of her abdomen after this event of respiratory failure with difficulty to intubate and she was noted to have some increased erythema around the graft site. her gastrostomy tube was placed to gravity due to the distention and nasogastric tube which had been placed was removed. the patient was successfully extubated again after response of her respiratory failure. she continued to slowly improve after these events. she slowly improved from her ventilatory standpoint and she was continued on tpn for support for this. a vac was placed over her wound site for her erythema and she was diuresed for her pulmonary status as well as for her fluid overload. the vac was managed by the plastic surgery service and was changed multiple times with assessment of her skin graft on every change. her donor site was doing well and continued on blow drying of the wound site and dressing changes. just prior to discharge to rehabilitation, her vac dressing was removed and two small areas of questionable success and viability of the graft were noted. it was decided that xeroform gauze dressing changes would be used over the skin graft site for continued wound care. she was restarted no her tube feeds on , after being held and which she tolerated. her tube feeds were slowly increased over the next couple days. the patient continued on broad spectrum antibiotics including vancomycin, levofloxacin, flagyl, zaroxolyn, fluconazole and as stated before zosyn. she was also given a course of linezolid. she was able to be weaned over a very long period down to a pressure support of 5 and peep of 5 and it is planned that the patient would be extubated after being successfully diuresed. her - drains which had been placed intraoperatively were removed by the plastic surgery service after decreased output was noted. after significant diuresis, the patient was able to tolerate extubation as well as able to tolerate low pressure support and minimal vent settings. therefore, it was decided the patient would be extubated. the patient was extubated on , which she was able to successfully maintain her oxygenation and breathe comfortably. the patient was started on a clear liquid diet on , which she tolerated. she had return of bowel function during her intensive care unit stay and her wounds remained clean, dry and intact. physical therapy as well as occupational therapy were consulted for ambulation as well as strength training as well as to manage all her deconditioning. speech and swallow was also consulted for a bedside evaluation which she did well with. orthopedics was consulted early due to knee pain and was found to have osteoarthritic changes of her knee. her white blood cell count rose after being off antibiotics and it was felt the patient had a line infection and therefore, she was started on zosyn. her tpn was stopped. she responded well to the zosyn and her white blood cell count had normalized prior to discharge. neurosurgery was also consulted for low back pain which was a chronic issue which she had had for multiple years. ultimately, it was felt that this pain was chronic degenerative changes and there was no plan for change in management. the patient also had some mild diarrhea which was controlled with imodium. her stool cultures were negative. the patient also underwent calorie counts which she did well with. on , plastic surgery took her back to the operating room for a repeat split thickness skin graft which she successfully underwent. this graft as mentioned before had two areas that ultimately looked questionable for viability and therefore, xeroform dressing changes were done. however, the remainder of the wound site was viable and nice. therefore, it was felt that the graft had taken quite nicely. her tube feeds were began to be cycled at that time and the patient was transferred out to the floor. she continued to do well and continued to do well from a dietary standpoint on regular diet and her tube feeds which were cycled were able to be stopped completely prior to discharge. she also completed as stated before a twenty-two day course of zosyn for infected line as well as for bacteremia. the vac was removed on , which again showed viable graft site. physical therapy had seen the patient and it was decided the patient should return to which is where she had been previously prior to long hospital course for further rehabilitation. the patient was tolerating a regular diet. it was planned also that the patient would keep her foley catheter for the time being and when the patient was more ambulatory and more functional, it could be removed in the rehabilitation facility. the patient was also planned to follow-up with dr. in three weeks time for evaluation as well as wound care check. she is also to be followed by dr. in the plastic surgery service for her skin graft and also for her abdominal closure. the patient was planned for discharge on , and was tolerating a regular diet without needing tube feeds. it was planned that the patient would be discharged to rehabilitation facility. discharge diagnoses: 1. enterocutaneous fistula, status post repair times two including a component separation and split thickness skin grafting by plastic surgery service. 2. small bowel obstruction, status post exploratory laparotomy and lysis of adhesions times two. 3. gastric bypass in the past. 4. cholecystectomy. 5. breast reduction. 6. multiple ventral hernia repairs. 7. enterocutaneous fistula formation previously from that. 8. hypothyroidism. 9. pancreatitis. 10. asthma. 11. history of pneumonia. 12. history of varicose veins. 13. status post respiratory failure requiring emergent reintubation. 14. multiple line infections and bacteremia requiring multiple antibiotic treatments with prolonged treatment times. medications on discharge: 1. protonix 40 mg p.o. once daily. 2. ativan 0.5 to 1 mg p.o. q4hours p.r.n. 3. ambien 5 mg p.o. q.h.s. 4. dilaudid 2 to 4 mg p.o. q4hours p.r.n. 5. loperamide 2 mg p.o. twice a day. 6. zinc sulfate 220 mg p.o. twice a day. 7. lopressor 75 mg p.o. twice a day. 8. paroxetine 20 mg p.o. once daily. 9. tylenol 325 to 650 mg p.o. q4hours p.r.n. 10. levoxyl 300 mcg p.o. once daily. 11. insulin sliding scale. 13. ipratropium inhaler four puffs four times a day. 14. albuterol four puffs q4hours p.r.n. 15. phenazopyridine 200 mg p.o. three times a day. 16. cycled tube feeds, one half strength impact, at 20cc per hour from 7:00 p.m. to 6:00 a.m. discharge status: the patient was discharged to rehabilitation facility in stable condition. follow-up: the patient is instructed to follow-up with dr. in three weeks time, with dr. in two to three weeks time, as well as follow-up with her primary care physician. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances other skin graft to other sites attachment of pedicle or flap graft to other sites closure of fistula of small intestine, except duodenum replacement of gastrostomy tube other and open repair of other hernia of anterior abdominal wall with graft or prosthesis other immobilization, pressure, and attention to wound other incision of small intestine injection or infusion of oxazolidinone class of antibiotics diagnoses: unspecified septicemia unspecified protein-calorie malnutrition infection and inflammatory reaction due to other vascular device, implant, and graft pneumonia due to klebsiella pneumoniae disruption of external operation (surgical) wound persistent postoperative fistula ventral, unspecified, hernia without mention of obstruction or gangrene osteoarthrosis, localized, not specified whether primary or secondary, lower leg 

Answer: The patient is high likely exposed to