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: macrodantin / sulfa (sulfonamides) attending: chief complaint: abdominal pain/distention recurrent small bowel obstruction major surgical or invasive procedure: 1.exploratory laparotomy, lysis of adhesions (1 hour), small bowel resection and anastomosis x1. 2.percutaneous endoscopic gastrostomy. history of present illness: 63 year old woman with c5 tetraplegic s/p (mva 30 years ago). patient has baseline partial ventilation dependence at night. she has had multiple prior obdominal surgeries with use of the abdominal wall bilaterallt for tissue transfers. she had been admitted and managed medically earlier this month for sbo (d/c'd ). she re-presented on this occasion with increased abdominal distention that had progressed throughout the day on and resulted in her going to hospital, there she had a ct that showed a distal sbo and she was transferred to for further care. past medical history: c5 quadraplegic s/p mva has chronic trach with ventilator dependence at night. anemia, recurrent utis, active decubiti r ischium. suprapubic tube, hyponatremia, s/p bladder augmentation using a cecal pedicle, l hip recurrent decubiti s/p use of abdominal wall flaps for treatment of chronic l hip osteomyelitis, now with vac treatment. history of adrenal insufficiency. social history: no smoking, no drinking, no etoh. lives with husband who is her primary caretaker family history: non-contributory physical exam: vitals: t97.8, hr 104, bp145/79, 98% 4l gen: nad, ngt placed neuro: quad pulm: diminished bt clear b/l cv: rrr abd: +bs, soft/nt, healed transverse and vertical scar. extreme attenuation of the entire abdominal wall. pertinent results: 01:20am pt-12.0 ptt-28.2 inr(pt)-1.0 01:20am wbc-8.1 rbc-3.50*# hgb-11.1*# hct-33.0*# mcv-94 mch-31.7 mchc-33.6 rdw-15.5 01:20am neuts-92.0* lymphs-4.3* monos-3.3 eos-0.3 basos-0.2 01:20am glucose-70 urea n-20 creat-0.3* sodium-137 potassium-2.8* chloride-103 total co2-21* anion gap-16 01:20am phosphate-3.3 magnesium-1.8 04:27pm type-art po2-186* pco2-46* ph-7.33* total co2-25 base xs--1 04:41am blood caltibc-85* ferritn-676* trf-65* 01:26am blood lactate-0.6 03:18pm blood freeca-1.14 abdomen (supine only) 3:15 am dilated loops of small bowel suggestive of small-bowel obstruction. limited evaluation of the colon and intrapelvic loops of bowel. pathology examination , a. 63 female small bowel (1). procedure date tissue received report date diagnosed by segment of small intestine with diffuse acute serositis extending to one resection margin; submucosal acute inflammation, edema, and vascular congestion with focal hemorrhage are also present. ct abdomen w/contrast, ct chest w/contrast 12:50 pm 1. multifocal pneumonia demonstrated by tree-in- opacities diffusely bilaterally and consolidation and volume loss within the right greater than left lower lobe. 2. small 6 mm left lower lobe pulmonary nodule. recommend followup ct following resolution of pneumonia. 3. mediastinal, hilar, and subclavicular lymphadenopathy. although this may be related to pneumonia, given the size and distribution of this lesion, other etiology should be considered such as lymphoma or sarcoid. recommend correlating with patient's clinical history. 4. tiny liver hypodensities in segment ii and segment vii that are not completely characterized. further evaluation with mri or multiphasic ct is suggested if clinically indicated. 5. moderate ascites. 6. diffuse small bowel wall thickening. this finding is fairly nonspecific, however the most likely possibility is diffuse edema secondary to third spacing, which is consistent with surrounding ascites. 7. mild-to-moderate right hydronephrosis and hydroureter. 8. ill defined heterogeneous area within the region of the patient's neobladder on the right side. the differential includes collapsed segment of an ileal pouch, cervical or lower uterine segment mass, or bladder mass. a fluoroscopic evaluation of the neobladder could be performed to evaluate for bladder mass. a pelvic ultrasound could further delinate the location of this lesion. ct chest w/contrast 11:44 am 1. distended fluid-filled colon raises the possibility of superficial colitis. no wall thickening or evidence of transmural colon disease. 2. persistent collapse of the lower lobes bilaterally. 3. improved peribronchial inflammatory changes in the right middle lobe and tree-in- centrilobular inflammatory opacities in the upper lobes bilaterally. 4. decrease in size in mediastinal lymphadenopathy. 5. hypodensities in the liver are too small to be characterized. 6. ascites. 7. mild improvement in small bowel wall thickening. 8. unchanged mild-to-moderate hydronephrosis on hydroureter. 9. stable ill-defined heterogeneously enhancing area in the region of the patient's neobladder on the right 10:37 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 3+ (5-10 per 1000x field): gram positive rod(s). respiratory culture (final ): moderate growth oropharyngeal flora. pseudomonas aeruginosa. moderate growth. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 4 s meropenem------------- 2 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ =>16 r 9:20 am bronchoalveolar lavage **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. 1+ (<1 per 1000x field): gram positive rod(s). respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. pseudomonas aeruginosa. >100,000 organisms/ml.. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | amikacin-------------- 16 s cefepime-------------- 4 s ceftazidime----------- 8 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 4 s meropenem------------- 4 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ =>16 r fungal culture (final ): yeast. 9:34 am stool consistency: loose source: stool. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). brief hospital course: the patient re-presented with sbo as described in the hpi above. she remained in icu care throughout given her vent and nursing needs. she was given gi/dvt prophylaxis throughout her stay. she was taken to surgery for loa and resection of a strictured segment of small bowel. she tolerated this surgery well and recovered rapidly, but then developed a pseudomonal pneumonia. she was treated with appropriate antibiotics but had a major setback on her ventilator status. she therefore became depressed and refused to eat. she was seen by psychiatry and started on pharmacotherapy for her advanced situational depression. she accepted placement of a peg for long term nutrition given her low po intake and difficulty with swallowing. she was evaluated on hd 17 for a question of intra-abdominal abscess/complication given her increased wbc and episodes of hypotension but none was found. this resolved and she remained stable up to just before d/c. she then had an episode of altered mental status associated with bradycardia. we wished to work that up but her husband nonetheless insisted on taking her home ama. she will go home with close care by her husband who is very skilled in her long term needs, and care, as well as home nursing care and apropriate services. the rest of her hospital stay is described below by systems. neuro: she is c5 quad x 30 years, and received appropriate nursing care given this, there was no changes. she expressed throughts of suicide and depression and psychiatry was c/s on hd 11 to help with her mental health needs. she has subsequently started to feel much better, have increased hope, concentration, better sleep and continues on citalopram upon d/c. pulm: she required ventilation during the evenings with her home regimen, and was slowly weened down on the rate of simv. she was treated for pseudomonas and klebsiela pna after +sputum and bal after bronch on hd 13. cv: she remained stable, through had minimal hypotension around hd 15-17, which responded to fluids/abx, worry of sepsis and no source of infection was found. otherwise no issues. gi/fen: the patient received abd washout, loa and sbr as described, plus a peg for inadequate po and continued tf requirements. c.diff was neg after concern secondary to multiple loose stools which have subsequently resolved. heme/id: she received abx tx for pneumonia as described above through her hospital stay and will be d/c'd on nafcillin. slightly elevated wbc as described above which was evaluated. she had pna and uti and this has resolved upon d/c gu/renal: uti tx appropriately, continues w/ foley wound. continues to have wound vac on chronic l inguinal/abd wound. no changes. medications on admission: oxycodone, fludrocortisone, ambien, ativan, flovent, prilosec, nafacillin 1. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day). 2. nafcillin in d2.4w 2 g/100 ml piggyback sig: one (1) intravenous q6h (every 6 hours). disp:*qs 120* refills:*0* 3. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: picc line care per protocol. disp:*qs 60 ml(s)* refills:*0* 4. lorazepam 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. disp:*30 tablet(s)* refills:*0* discharge medications: 1. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. hexavitamin tablet sig: one (1) cap po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. nystatin-triamcinolone 100,000-0.1 unit/g-% cream sig: one (1) appl topical prn as needed for rash: under breasts. disp:*1 1* refills:*0* 6. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 1* refills:*2* 8. albuterol 90 mcg/actuation aerosol sig: 4-6 puffs inhalation q4 h prn as needed for wheeze. disp:*1 1* refills:*2* 9. hydromorphone 2 mg tablet sig: one (1) tablet po q8h prn as needed for pain. disp:*70 tablet(s)* refills:*0* 10. zolpidem 5 mg tablet sig: 0.5 tablet po hs prn as needed for insomnia. disp:*30 tablet(s)* refills:*0* 11. sodium chloride 0.9 % 0.9 % parenteral solution sig: three (3) ml intravenous daily (daily) as needed: to flush line. 12. picc line care per protocol 13. nafcillin in d2.4w 2 g/100 ml piggyback sig: one (1) intravenous q6h (every 6 hours). disp:*120 * refills:*0* 14. tube feeds replete w/fiber full strength-ok to start -additives: banana flakes, 3 packets per day -starting rate:80 ml/hr; do not advance rate goal rate:80ml/hr -cycle?: yes, starting now cycle start:1800 cycle end:0800 -residual check:q6 hold feeding for residual >= :100 ml flush w/ 50 ml water q6h discharge disposition: home with service facility: area vna discharge diagnosis: 1.small bowel obstruction 2.pneumonia 3.hypotension discharge condition: stable, off vent with trach and peg discharge instructions: please call your pcp or seek emergency care if you experience fever greater than 101.4 f, nausea/vomiting, severe abdominal pain, chills, problems with your feeding, or any other symptoms that are worrisime to you. followup instructions: please follow up with dr. in weeks, or earlier if you have problems or issues that need urgent but not emregency attention. please call to arrange an appointment. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other partial resection of small intestine enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus other lysis of peritoneal adhesions other immobilization, pressure, and attention to wound other injection into sympathetic nerve or ganglion other hernia repair diagnoses: other iatrogenic hypotension urinary tract infection, site not specified hyposmolality and/or hyponatremia other specified intestinal obstruction other specified cardiac dysrhythmias pneumonia due to pseudomonas hernia of other specified sites, with obstruction other malaise and fatigue attention to other artificial opening of urinary tract pneumonia due to klebsiella pneumoniae dependence on respirator, status attention to tracheostomy chronic osteomyelitis, pelvic region and thigh other specified disorders of intestine adjustment disorder with depressed mood pressure ulcer, hip quadriplegia, c5-c7, complete 

Answer: The patient is high likely exposed to