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: lisinopril / metformin attending: chief complaint: sepsis major surgical or invasive procedure: ex lap, extended right colectomy, end ileostomy redo ex lap, subtotal colectomy, mucous fistula history of present illness: 85f well known to the acs service, transferred from rehab, 12 days s/p ex-lap, right colectomy, and end ileostomy for lower gi bleeding localized to the cecum. by report from the facility, ms. developed increasing abdominal pain associated with minimal ileostomy output, one episode of vomiting, and fever to 100.8 earlier today. she had been npo secondary to nausea, but had a stable hematocrit and normal wbc during her 5 day rehab stay. past medical history: diabetes dyslipidemia hypertension atrial fibrillation hypothyroidism osteoarthritis, s/p bilateral knee replacements in depression asthma, diagnosed in c-sections in past social history: husband died many years ago. patient lives with her granddaughter who is her proxy. smoked 36 years x 1 ppd, quit in , remote social etoh. family history: family history of cva/cad. physical exam: vitals: 99.6 127 118/76 26 100% gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: irregular, mildly tachycardic 110-120 pulm: diminished bilaterally abd: soft, mildly distended, +peristomal ttp in the rlq, no rebound or guarding, no palpable masses. rlq end ileostomy flush with abdominal skin, pink, small amount of watery brown effluent, no flatus in bag. tender with digitalization. midline laparotomy incision with vac in place, no erythema, induration, drainage, or hernia. left sided mucous fistula with scant mucous output. ext: no le edema, le warm and well perfused pertinent results: admission 8.0 > 29.5 < 486 n:65 band:15 l:12 m:8 e:0 bas:0 133 97 34 < 161 agap=13 ------------ 4.3 27 1.5 ca: 6.9 mg: 1.8 p: 3.2 alt: 23 ap: 125 tbili: 0.5 alb: 3.2 ast: 26 lip: 26 lactate:1.9 admission ctap ct a/p: 1. sbo w/ transition pt at ileostomy exit site; cause appears to be mass effect from herniated mesenteric fat adjacent to the ileostomy. 2. s/p r colectomy w/ tiny locules of gas adjacent to colonic staple line - may be post-operative although leak cannot be excluded. 3. small amt of complex free fluid in abdomen/pelvis - ddx includes or bowel leak contents - correlate w/ exam and hct. discharge: 6:33 am sputum source: endotracheal. **final report ** gram stain (final ): <10 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. quality of specimen cannot be assessed. respiratory culture (final ): rare growth commensal respiratory flora. culture workup requested by dr. . stenotrophomonas (xanthomonas) maltophilia. moderate growth. klebsiella pneumoniae. sparse growth. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ stenotrophomonas (xanthomonas) maltophilia | klebsiella pneumoniae | | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- <=0.25 s gentamicin------------ <=1 s meropenem------------- <=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s <=1 s 02:08am wbc-11.5* rbc-2.76* hgb-8.2* hct-25.6* mcv-93 mch-29.8 mchc-32.0 rdw-16.3* plt ct-458* 02:08am pt-13.6* ptt-28.2 inr(pt)-1.3* 02:08am glucose-131* urean-19 creat-1.0 na-131* k-4.6 cl-93* hco3-29 angap-14 02:08am calcium-8.0* phos-4.2 mg-2.0 brief hospital course: neuro: on arrival, the patient was awake, but minimally alert and seemed to be unaware of her surroundings. over the course of her stay, she was maintained on the minimum amount of pain medication necessary to adequately control her pain. as a stay progress, she became more alert and interactive, and after extubation, was alert, oriented, and very interactive. at the time of discharge, the patient was alert, oriented times three, and had a nonfocal neurologic exam. she was moving all four extremities, and complained only of tenderness of the abdomen. still sluggish with decreased interactiveness but appropriate. cv: initially, the patient was tachycardic ranging up to 140. she initially required a diltiazem drip to control her tachycardia, but as her stay progressed, the diltiazem drip was weaned, and she was restarted on her home rate control medications. she also initially required some low doses of neo-synephrine. this was weaned to fully off finally on hospital day seven, and she did not require any more pressors. she is now controlled well on an oral diltiazema and metoprolol regimen. she has not yet restarted her isosorbide, diovan, or pradaxa. those are currently on hold. the patient has atrial fibrillation at baseline and fluctuates from sinus tachycardia into afib with rate control 90-115 and stable pressures. r: after her surgery, the patient was vent dependent for several days. on post operative day two, she was weaned to pressure support. she remained on these settings until postoperative day nine, after which she was extubated. from that point on, she tolerated minimal oxygen, and room air. after extubation, the decision was made by the family, after a long family meeting, to make the patient dnr/dni. she is getting albuterol and ipratropium inhalers as needed. gi: on postoperative day two, she began to have stool from her ostomy. her tube feeds restarted on postoperative day four and she continued to tolerate these throughout her stay. on postoperative day 11, she failed a speech and swallow test, after extubation, and had a dobhoff feeding tube placed, as she had initially had an ogt while intubated. on postoperative day one, the patient had a wound vac placed over the midline laparotomy incision. last change . end ileostomy with stool output, scant mucous output from mucous fistula. two jp drains from or removed prior to discharge. famotidine prophylaxis ongoing. gu: the patient made adequate urine throughout her stay, which was monitored with the catheter. on postoperative day six, she began to have signs consistent with pulmonary edema. she was started on a lasix drip , but was only slightly negative for the first several days. on postoperative day nine, she began to diurese quite effectively, with no compromise of her hemodynamic stability. on postoperative day 11, lasix drip as stopped and she was continued on intermittent lasix. she continued to have excellent output after this. she should continue to have close monitoring of i's and o's and urine output. heme: in total, the patient received two units of packed red cells. her hematocrit was monitored frequently. after her surgery, her hematocrit remained stable throughout her stay. pradaxa is being held at this time because it cannot be crushed via the dophoff tube. the patient's pcp should determine the patient's risk for stroke in setting of afib. for now no anticoagulation. heparin prophylaxis should continue 5000 units sc tid. id: during the perioperative period, the patient was initially placed on vancomycin and zosyn. the vancomycin was stopped shortly after surgery. a culture from the wound on grew back pan sensitive e. coli, and the patient antibiotics were changed to bactrim. she had two sputum, and two urine cultures which grew back only bacteria sensitive to bactrim. she was discharged on a two-week course of bactrim. her white cell count was monitored throughout her stay. medications on admission: albuterol hfa 90 q4-6h prn, cardiazem la 240', diovan 160', loratadine 10 prn, pradaxa 150'', allopurinol 200', vit d3 1000', lasix 40', glyburide 2.5', isosorbide mononitrate er 30', levothyroxine 112', metoprolol er 100', oxybutynin 5', pravastatin 40' discharge medications: 1. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 2. diltiazem 60 mg po qid 3. famotidine 20 mg po q12h 4. furosemide 20 mg po bid 5. heparin 5000 unit sc tid 6. glucagon 1 mg im q15min:prn hypoglycemia protocol 7. metoprolol tartrate 25 mg po bid hold for hr< 60 8. ondansetron 4 mg iv q8h:prn nausea 9. 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. 10. sulfameth/trimethoprim ds 3 tab po tid 12-15mg/kg/day trimethoprim component for tx stenotrophomonas, per pharmacy recs 11. 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. 12. hydromorphone (dilaudid) 0.5-1 mg iv q2h:prn pain 13. levothyroxine sodium 112 mcg po/ng daily 14. glargine 10 units q24h insulin sc sliding scale using reg insulin 15. ipratropium bromide mdi 2 puff ih q8h:prn wheeze / dyspnea 16. valsartan 160 mg po/ng daily (not yet restarted) 17. albuterol inhaler puff ih q4h:prn wheeze 18. isosorbide mononitrate (extended release) 30 mg po daily (not yet restarted) 19. oxybutynin 5 mg po daily (not yet restarted) 20. vitamin d 800 unit po daily (not yet restarted) 21. pravastatin 40 mg po daily (not yet restarted) 22. allopurinol 200 mg po daily (not yet restarted) 23. glyburide 2.5 mg po daily (not yet restarted) 24. medication alert please note med rec -> medications that had not been restarted as of discharge from on were noted. restart these medications as appropriate in conversation with dr. pcp and rehab physician. the medications that the patient was getting during her stay include po diltiazem, po metoprolol, po lasix, po bactrim, synthroid, insulin sliding scale and glargine as written, electrolyte repletion, heparin prophylaxis. dilaudid and tylenol as needed for pain and zofran for nausea. the other listed medications that the patient was taking at home prior to admission were not restarted. thank you. 25. acetaminophen 325-650 mg po/ng q6h:prn pain 26. dabigatran etexilate 150 mg po bid (not yet restarted) discharge disposition: extended care facility: for the aged - macu discharge diagnosis: anastamotic leak, colon necrosis discharge condition: good discharge instructions: continue vac dressing changes every 3 days and close wound monitoring. call the acute care surgery clinic if there are any concerns about the wound appearance. last vac change was at . the patient did have two jp drains which were removed during her stay at . monitor those skin sites and use dry dressings as needed. please continue ostomy teaching and management. the patient has an end ileostomy and mucous fistula in place. please call acute care clinic if concern with appearance or amount of ostomy output, monitor for dehydration, bloody or melenic output. patient is on an antibiotic course with bactrim to cover for klebsiella and stenotrophomonas in her sputum cultures. she will complete a two week total course of antibiotics. her last positive culture was on . she will continue the bactrim through . the patient is taking diltiazem and metoprolol via the dophoff tube to rate control her atrial fibrillation. her pradaxa is currently on hold. she should get prophylactic heparin 5000 units three times daily. discussion should be had with dr. , ms. primary care provider : anticoagulation. patient had been on coumadin in the past and one year ago was transitioned to pradaxa. she is not on aspirin. her initial presentation in early was with gi bleeding while on pradaxa. please discuss risks and benefits of anticoagulating again once the patient passes speech and swallow. for now she will remain with her dophoff tube, tube feeds, and oral medications as possible. pradaxa will be held. no coumadin or aspirin to be started at this point. discuss this issue with dr. in determining how to move forward with anticoagulating. the patient did not pass her speech and swallow on so a dophoff tube was placed and tube feeds and medications have been given through there. the dophoff should be flushed with 30cc q6 as well as additional flush as needed with crushed pills to prevent clogging. the patient is also being diruesed. had been on a lasix drip for over a week and was transitioned to lasix via the dophoff tube on . she is being discharged on 20mg lasix via dophoff, please closely monitor electrolytes and bun/cr and back off on diuresis as needed. continue other home medications as able to give via dophoff. continue reassessing speech and swallow ability to transition to oral feeding and medications. call clinic with concerns about ostomy output, inability to tolerate tube feeds, increasing abdominal pain, or other concerns. followup instructions: provider: care clinic phone: date/time: 1:00 provider: , .d. phone: date/time: 10:50 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other and unspecified partial excision of large intestine arterial catheterization colostomy, not otherwise specified diagnoses: other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia unspecified acquired hypothyroidism cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation perforation of intestine acute on chronic diastolic heart failure asthma, unspecified type, unspecified personal history of tobacco use depressive disorder, not elsewhere classified sepsis chronic kidney disease, unspecified alkalosis peritoneal adhesions (postoperative) (postinfection) other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation dehydration acute vascular insufficiency of intestine knee joint replacement peritoneal abscess ileostomy status delirium due to conditions classified elsewhere other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other and unspecified escherichia coli [e. coli] acute respiratory failure following trauma and surgery abnormal sputum acquired absence of intestine (large) (small) other digestive system complications 

Answer: The patient is high likely exposed to