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: penicillins / vancomycin / levofloxacin / unasyn / tigecycline attending: chief complaint: pancreatitis major surgical or invasive procedure: endotrachial intubation and tracheostomy multiple central lines placements, right ij and left subclavian picc line history of present illness: 64 year-old m with pmhx of dmii, htn, hld, chf, cad s/p cabg in , presented to osh with ruq/epigastric pain radiating to the back, + n/v/distension and found to have pancreatitis and cholecystitis. lower abdomenal pain started while patient was sleeping on the night before presentation. continued to worsen over the course of the night, not positional, started to have back pain in the same band like fashion, then right upper quadrant pain. patient last had bm on the day prior, small, non-bloody x2. does not carry dx of diverticulitis or divertivulosis. never had these symptoms prior. denies sick contacts, recent trauma, travel or alcohol use. never had surgery to the bowel, no h/o hernia. reported positive n/v/chills, but no fevers. patient is obese with bmi of 44.6. at the osh, he was found to have wbc to 17.1 (94% p), lipase of 946, transaminitis (ast 156, alt 121), creatinine of 1.7, glucose of 336, d-dimer of 3050, troponin was flat. ruq u/s and ct abdomen were done. findings were consistent with pancreatitis and acalculus cholecystitis. pt was evaluated by surgeons. vital signs were 150/80; afebrile. he recieved flagyl/cetaz and 1l bolus and maintenance. on the floor, initial vs were: t: 98.9 bp: 132/72 p: 107 r: 34 o2: 97%. patient was given pain medication and fluid resus. review of sytems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: dm ii with neuropath chf (ef 35-40% tte) htn hyperlipidemia pna - treated at mssa epidural abscess s/p laminectomy - acute on chronic systolic heart failure social history: divorced, lives alone in , ma. retired high school english teacher. former cigar smoker, cigars/day, quit 8 years ago. rare etoh use, no illicits. family history: dad passed away from complications of cad (mi in 60s) and chf. mother had an mi in her 50s. sister with obesity, dm. physical exam: exam on admission - vitals: t: 98.9 bp: 132/72 p: 107 r: 34 o2: 97% general: alert, oriented, no acute distress, morbidly obese heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, mildly tender, non-distended, bowel sounds present, no rebound tenderness or guarding, positive ruq tenderness. gu: no foley exam on discharge - vs tcurrent 99, tmax 99.3 bp: 137/62 (range 114/54- 149/81) hr: 113 (range 109-123) rr: 19 (15-32) sao2: 96% on trach mask gen: alert, oriented pleasant obese m in nad heent: eomi, perrla, anicteric sclerae, mmm, o/p clear neck: supple, no jvd, no lad cv: tachycardic rate, regular rhythm, nl s1, s2 no murmurs appreciated lungs: ctab/l no wheeze/rales/rhonchi abd: obese, soft +bs, nontender to palpation, nondistended ext: b/l le edema 2+, distal pulses palpable skin: multiple excoriated skin lesions b/l ue, le, hands, healed and crusted over exfoliative desquamating lesions neuro: a&ox3, appropriate, able to follow commands, speaking full sentences in hoarse voice pertinent results: initial labs: 08:56pm blood wbc-23.1*# rbc-6.14# hgb-17.9# hct-56.5*# mcv-92# mch-29.1 mchc-31.6 rdw-13.2 plt ct-219 08:56pm blood neuts-90.8* lymphs-4.0* monos-4.9 eos-0 baso-0.3 08:56pm blood pt-13.0 ptt-21.7* inr(pt)-1.1 08:56pm blood glucose-277* urean-33* creat-1.7* na-137 k-5.2* cl-102 hco3-18* angap-22* 08:56pm blood alt-85* ast-55* ld(ldh)-388* alkphos-70 totbili-1.1 08:56pm blood lipase-1164* 08:56pm blood albumin-3.9 calcium-8.3* phos-3.6 mg-1.8 cholest-125 08:56pm blood %hba1c-6.2* eag-131* 08:56pm blood triglyc-86 hdl-47 chol/hd-2.7 ldlcalc-61 10:45am blood type-art po2-81* pco2-33* ph-7.36 caltco2-19* base xs--5 10:45am blood lactate-1.8 lft trend: 08:56pm blood alt-85* ast-55* ld(ldh)-388* alkphos-70 totbili-1.1 04:22am blood alt-16 ast-19 ld(ldh)-385* alkphos-39* totbili-1.1 04:02pm blood amylase-24 04:08am blood alt-15 ast-35 ld(ldh)-399* alkphos-63 totbili-0.4 04:56am blood alt-13 ast-32 ld(ldh)-326* alkphos-71 totbili-0.5 02:43am blood alt-15 ast-38 ld(ldh)-301* ck(cpk)-55 alkphos-81 totbili-0.5 03:31am blood alt-18 ast-29 alkphos-89 amylase-27 totbili-0.3 04:19am blood alt-7 ast-18 alkphos-65 totbili-0.5 08:56pm blood lipase-1164* 04:30am blood lipase-977* 04:22am blood lipase-50 04:02pm blood lipase-18 03:31am blood lipase-35 01:30am blood lipase-25 03:48am blood lipase-23 urine studies: 12:17am urine color-yellow appear-hazy sp -1.018 12:17am urine blood-mod nitrite-neg protein-30 glucose-300 ketone-10 bilirub-neg urobiln-neg ph-5.5 leuks-neg 12:17am urine rbc-2 wbc-3 bacteri-none yeast-none epi-<1 12:17am urine castgr-3* casthy-20* 04:07pm urine color-yellow appear-clear sp -1.020 04:07pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-5.0 leuks-neg 04:07pm urine rbc-3* wbc-1 bacteri-few yeast-none epi-0 03:20pm urine castgr-4* casthy-4* 09:59am urine hours-random urean-934 creat-74 na-23 k-41 cl-36 microbiology: respiratory culture-preliminary {gram negative rod(s) sputum gram stain - gram negative rod #1, acinetobacter baumannii complex blood culture - acinetobacter baumannii; staphylococcus, coagulase negative} blood culture - enterococcus faecalis blood culture - enterococcus faecalis blood culture - enterococcus faecalis; staphylococcus, coagulase negative blood culture - enterococcus faecalis; staphylococcus, coagulase negative blood culture - staphylococcus; coagulase negative blood culture - staphylococcus; coagulase negative catheter tip-iv wound culture-final staphylococcus, coagulase negative} swab gram stain-final; wound culture-final staphylococcus, coagulase negative swab gram stain-final; wound culture-final staphylococcus, coagulase negative imaging: cxr () - opacification in the infrahilar left lung suggests that it is still once again collapsed. small left pleural effusion is minimal, if any. new right infrahilar atelectasis is moderate to severe. upper lungs clear. the heart is not enlarged. no pneumothorax. nasogastric tube can be traced as far as the lower esophagus but the tip is not distinct. on a subsequent radiograph, 9:13 a.m. on , it ends in the stomach. ct a/p () - impression: 1. edema and peripancreatic stranding consistent with pancreatitis. focal area of hypoenhancement involving the pancreatic neck and portions of the body and head, which are most consistent with early pancreatic necrosis. 2. edema within the duodenal wall and gallbladder likely reactive in nature. 3. indeterminant 3-cm cystic appearing lesion exophytic off the upper pole of the left kidney in addition to multiple bilateral simple renal cysts. a renal ultrasound or mri may be obtained for further characterization the the 3cm indeterminate lesion as the patient's clinical condition warrants. 4. small bilateral pleural effusions and adjacent airspace disease likely representing predominantly atelectasis. echo (): the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. grossly normal valve morphology without pathologic flow identified. cta torso (): 1. no definite pulmonary embolism identified. limited evaluation of the subsegmental branches on the left and the segmental and subsegmental branches of the right pulmonary arteries secondary to bolus timing. 2. progression of marked edema and peripancreatic stranding, consistent with patient's history of pancreatitis. focal area of hypoenhancement involving the pancreatic neck and portions of the body and head, most suggestive of pancreatic necrosis. no organized fluid collections identified. 3. indeterminate 3 cm cystic lesion exophytic off the upper pole of the left kidney in addition to multiple bilateral renal cysts, which are redemonstrated. a renal ultrasound or mri may be obtained for further characterization as previously recommended on an outpatient basis. 5. small left pleural effusion and adjacent airspace disease, most likely representing atelectasis. 6. an 8 mm filling defect within the splenic vein which may represent a tiny nonocclusive splenic vein thrombosis. kub (): findings: as compared to the previous radiograph, there is no relevant change. the monitoring and support devices are in unchanged position. unchanged slight right hilar enlargement, retrocardiac atelectasis and suspicion of a small left-sided pleural effusion. no newly occurred focal parenchymal opacities. moderate overhydration. ct abd () - impression: 1. unchanged appearance of pancreas compatible with pancreatitis and areas of pancreatic necrosis at the pancreatic head, body and, to a lesser extent, tail. 2. unchanged appearance to bilateral renal cystic lesions which may be further evaluated with ultrasound or mri on a non-emergent basis. 3. bibasilar atelectasis with small bilateral pleural effusions, more marked on the left. echo (): the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. 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 appears normal (lvef 50-60%). there is no ventricular septal defect. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. tricuspid regurgitation is present but cannot be quantified. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , no definite . if indicated, a tee would be better to exclude a small valvular vegetation. tee (): no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. no vegetation/mass is seen on the pulmonic valve. impression: no echocardiographic evidence of endocarditis or paravalvar abcess. ct abd () markedly limited iv bolus timing secondary to hand injection, particularly limiting evaluation of potential vascular complication. 1. extensive pancreatic necrosis. although the quantity of fluid associated with necrotic tissue appears slightly increased, residual enhancing areas of the pancreas are similar in extent. although gas formation is not noted in the pancreatic fluid collection, infection of necrosis cannot be excluded. 2. new mild diffuse bowel dilatation suggestive of a very mild ileus. upper ext u/s () - impression: no evidence of thrombosis seen in right or left internal jugular or subclavian veins. kub () - two portable views of the abdomen were obtained, both supine. one includes the diaphragms and the other includes the obturator foramina. there are multiple loops of dilated small bowel. gas is seen throughout much of the colon -- the colon is distended, but not frankly dilated. the appearance is in keeping with the appearance on the ct scout film from . the most likely etiology is ileus, though a partial small- bowel obstruction cannot be excluded. cxr () - lung volumes are very low, crowding all of the normal structures and abnormalities. since although heart size may have increased only mildly, there is more mediastinal vascular engorgement and dilatation of upper lobe pulmonary vessels due to worsening cardiac decompensation or volume overload. confluent opacification at the lung bases could be explained by combination of atelectasis and confluent edema though radiographically one cannot exclude aspiration or even pneumonia. pleural effusions if any are small. tracheostomy tube in standard placement. tip of the left subclavian line projects over the junction of the brachiocephalic veins. no pneumothorax. nasogastric tube passes into the stomach and out of view. cxr ()- 1. the right picc line tip is now in the right atrium. 2. enlargement of the cardiopericardial silhouette with pulmonary vascular congestion and bilateral pleural effusions, unchanged, and likely related to volume overload/congestive heart failure. the study and the report were reviewed by the staff radiologist. ct abd/pelvis (pancreas protocol- )- 1. stable extent of necrotizing pancreatitis with the largest area of hypoenhancement centered along the proximal body. no venous thrombosis or arterial pseudoaneurysm. no pseudoaneurysm. slight increase in small ascites. 2. persistent mild ileus. 3. interval improvement of mild anasarca. kub- nasointestinal tube placement - post-pyloric feeding tube placement complete without complications. incidental note of intestinal distension cxr ()- no acute cardiopulmonary process. stable lung volumes and interval improvement in left basilar opacification. brief hospital course: mr. is a 64 year old male with history of with htn, dmii, hld, morbid obesity who presented with severe acute necrotizing pancreatitis. 1. necrotizing pancreatitis: etiology of the patient's pancreatitis was not clear. ct imaging revealed a partially-necrosed pancreas with a fluid collection. there was no history of significant etoh use, triglycerides were wnl, he had not had a recent ercp or steroid use, and there was no evidence of gallstones on imaging. his score was calculated to be >7. he received aggressive fluid resuscitation and was started on iv meropenem. given his very significant resuscitation requirements, the patient was intubated to maintain oxygenation and ventilation in the setting of worsening anasarca and third-spacing of fluid. surgery did not feel that his presentation warranted operative management. the patient initially began to show interval improvement after the first 48 hours as measured by lab abnormalities and fluid resuscitaton requirements, but then again decompensated with fevers > 103, a precipitous rise in wbc, a diffuse rash, and hypotension requiring more aggressive fluid resuscitation and eventual initiation of vasopressors. repeat imaging showed no evidence of progression of necrotic pancreas or other any intra-abdominal process. the patient was empirically switched to aztreonam/flagyl given concern for a drug-induced reaction (see below). the patient was followed with serial ct scans of his pancreas, which ultimately showed extensive pancreatic necrosis. he was maintained on tpn until he was able to tolerate enteric feeding. his clinical course was complicated by development of an ileus. his ileus was followed with serial kub's and eventually improved. due to significant difficulty placing a post-pyloric feeding tube, he had an ng tube placed and was started on tube feeds, which he tolerated. he had a post-pyloric feeding tube placed on and tube feeds were continued. at the time of discharge, he was tolerating tube feeds well and did not require tpn. 2. respiratory distress: his respiratory failure was secondary to lll collapse and pulmonary edema and increased abdominal distension from ileus and anascarca. requiring peep initially as high as 18 likely secondary to increased intrabdominal pressure. when blood pressue was stable and he was able to be diuresed, he began to require less positive pressure. dead space measurement did not reveal a significant amount of dead space present, and he was able to increasingly tolerate pressure support. ultimately, he underwent trach placement. he was transitioned to trach mask ventilation and had a passy-muir valve placed. of note, on the afternoon after having the sutures removed from his tracheostomy site, the patient's trach tube was noted to be out of proper position. anesthesia and ct surgery urgently evaluated the patient. he was transiently intubated, and his trach was replaced at the bedside. the patient did not have any further problems with his tracheostomy. as he approached discharge, the patient remained grossly fluid overloaded. diuresis with iv lasix should be continued with a goal of l negative a day. at the time of discharge he is slighly positive for length of stay. he will require further weaning from the trach mask. 3. bacteremia/ fevers: as above, he was initially started on meropenem on admission for severe pancreatitis. the meropenum was transitioned to aztreonam after he developed skin changes concerning for an allergic reaction. he continued to spike daily fevers, which were felt to possibly be related to his pancreatitis but also possibly related to an underlying infection. eventually, he grew coag neg staph sensitive to linezolid in consecutive blood cultures from and then coag neg staph that was resistant to linezolid in a blood culture on . additionally, he grew pan-sensitive enterococcus faecalis in consecutive blood cultures from . his central venous lines were the suspected source. however, his diffuse skin breakdown in the setting of his allergic reaction was also thought to be a possible source of his staph. he underwent multiple cvl changes, given these positive cultures. tee negative for vegetations or abscesses. also, he grew acinetobacter from a right ij blood cx on and from multiple sputum cultures. given his various positive cultures, he was followed by the infectious disease service, who recommended various adjustments to his antibiotic regimen. he was unable to be started on vancomycin because of a questionable history allergy reported from another facility. allergy was consulted and felt that he is unlikely to be allergic to vancomycin; however, to be safe he should undergo a desensitization if vancomycin was necessary. he was placed on aztreonam, amikacin, and linezolid. however, aztreonam was ultimately stopped as it appeared that the acinetobacter was not susceptible. he was tried on tigecycline but developed a questionable allergic reaction. at the time of discharge, the infectious disease team recommended a total 14 day course of amikacin to end on . 3. skin rash: as above, the patient was initially started on meropenem on admission. however, he thereafter developed a clinical decompensation, including a diffuse rash. this rash consisted of significant erythema and desquamation and ultimately covered a significant portion of the patient's upper and lower extremities as well as his trunk. when he developed this rash, he was empirically switched to aztreonam/flagyl given concern for a drug-induced reaction (i.e. dress syndrome). dermatology was consulted and agreed that the rash likely represented a drug reaction but felt that the likely inciting was unasyn approximately two weeks prior to rash development. biopsies were performed and were also consistent with a hypersensitivity reaction. later in his hospital course, the patient was started on tigecycline, after which he was noted to develop a new papular rash, concerning for an allergy. the tigecycline was promptly discontinued. allergy and immunology was consulted to comment on patient's multiple skin reactions to various antibiotics, and it was thought the culprit was tigecycline since it correlated to his time course. however, if tigecycline would be needed in the future, the patient could undergo desensitization. pt's skin rash improved throughout hospital course and he was seen multiple times by the wound care team who left excellent recommendations for care, which was transcribed into his discharge paperwork for continuation at rehab. 4. abdominal distention/ ileus : the hospital course was complicated by a prolonged ileus. there was some initial concern for c.diff, and he was kept on flagyl for an extended period of time, given the impossibility of collecting stool samples. however, stool samples were eventually negative for c. diff. his ileus was followed by serial kub's. after several unsuccessful attempts at placement of a post-pyloric feeding tube, he was started on gastric tube feedings. he subsequently developed marked abdominal distention and tube feeds were held. his ileus improved after weaning narcotics and a few doses of methylnaltrexone. after the patient's ileus improved, he was restarted on tube feeds and tolerated them well. 5. agitation/ delerium: given his intubation, the patient was initially on large amounts of iv sedation. after tracheostomy placement, the patient's sedation was weaned. in the setting of weaning his sedation, he began to experience some agitation and delirium, for which he was started on standing methadone and haldol. as these medications were tapered, he was started on standing seroquel. at time of discharge, pt was a&ox3, at his baseline and had good insight into his condition. 6. distributive shock: his pancreatitis was complicated by hypotension, ultimately requiring pressors. the etiology was likely multifactoiral, including his pancreatitis, his bacteremia, and his sedation while he was intubated. as his clinical status improved and his sedation was weaned, his hypotension improved and his pressors were weaned and stopped. 7. acute kidney injury: the patient presented with acute renal failure, which initially improved with iv hydration. his hospital course was complicated by some additional elevations in his creatining, generally in the setting of ct scans. at the time of discharge, his creatinine was stable and within normal limits. 8. anemia patient's hematocrit slowely trended down during his hospitalization. ng tube contents and stool were both guaiac negative, and felt to be secondary to repeated phelbotomy. his hematocrit was trended and he was transfused prn to maintain a hct above 21. his blood counts had been stable for several days prior to discharge. 9. type ii diabetes, c/b neuropathy: the patient was continued on sliding scale insulin and was given insulin in his tpn. following transfer from tpn to tube feeds he required lantus and an insulin sliding scale with meals. due to high blood sugars, lantus 10u daily was added to his regimen, and he will continue on hospital humalog sliding scale, which may need to be adjusted as appropriate. medications on admission: transfer meds: tylenol 650 q6h heparin 5000u sq q12h dilaudid pca not started lisinopril 20 mg daily metoprolol 100 mg daily metoprolol 50 mg qhs zofran 4mg q6h prn zocor 20 mg po home meds: aspirin 81mg daily metformin 500mg metoprolol 200mg am 100mg pm glyburide 5mg lisinopril 20mg daily amlodipine 5mg daily neuremedy 150mg discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 3. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 4. amikacin 880 mg iv q24h duration: 5 days 5. furosemide 40 mg iv bid start: in am 6. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day). 7. famotidine 20 mg iv q12h 8. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 9. diphenhydramine 50 mg iv q6h:prn rash 10. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 11. ondansetron 4 mg iv q8h:prn nausea 12. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 13. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 14. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 15. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 16. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 18. mupirocin calcium 2 % cream sig: one (1) appl topical (2 times a day). 19. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 20. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 21. mineral oil oil sig: 15-30 mls po daily (daily). 22. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: four (4) puff inhalation q4h (every 4 hours) as needed for wheezing. 23. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed) as needed for nj tube placement. 24. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 25. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 26. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever/pain. 27. insulin glargine 100 unit/ml cartridge sig: ten (10) units subcutaneous qam. 28. insulin lispro 100 unit/ml cartridge sig: asdir subcutaneous asdir: as directed by inpatient humalog (lispro) sliding scale. discharge disposition: extended care facility: pavilion - discharge diagnosis: primary: necrotizing pancreatitis and distributive shock respiratory failure requiring tracheostomy bactermia with coagulase negative staphylcoccus, enterococcus and acinetobacter at various points during his hospitalization. desquamating hypersensitivity skin rash secondary: diabetes mellitus, type ii. congestive heart failure hypertension delerium acute kidney injury anemia ileus discharge condition: level of consciousness: alert and interactive. mental status: confused - sometimes. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure caring for you during this hospitalization. you were admitted for severe pancreatitis, complicated by respiratory failure, shock, and multiple blood stream infections. the cause of your pancreatitis is unknown, but you should not drink alcohol anymore as you are at high risk of losing complete function in your pancreas. in addition, you were noted to have a severe allergic skin reaction most likely related to unasyn, but possibly due to meropenum. you also developed a worsening skin rash after being started on tigecycline. please do not take any of these medications in the future. there have been multiple changes to your medications during this hospitalization. please stop all of your previous medications, and follow the medication list provided to you and to your rehabilitation facility. you will need to take amikacin for 14 day course, to end on we also added lantus 10 units in the morning, because your sugars were high. please take only the medications listed in your medication list provided after this hospitalization. followup instructions: called insurance pcp, , . , and was informed that patient has never been seen in that clinic before. patient will need new pcp prior to leaving rehab facility. will need to have tsh, t4 re-checked w/ new pcp md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances insertion of other (naso-)gastric tube temporary tracheostomy closed biopsy of skin and subcutaneous tissue diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes acute respiratory failure bacteremia chronic systolic heart failure paralytic ileus dermatitis due to drugs and medicines taken internally streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus delirium due to conditions classified elsewhere acute pancreatitis long-term (current) use of aspirin other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms shock, unspecified penicillins causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to