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: the patient is a 44-year-old female with multiple sclerosis and a history of tracheostomy and percutaneous endoscopic gastrostomy tube placement in who developed hematuria one day prior to admission. she received one dose of levaquin at home and had a slight fever. then, at 10 p.m. one day prior to admission, she became more lethargic, and her blood pressure dropped to 60/palpable (usually 130s/90s). otherwise, no other localizing symptoms. between emergency medical service and the emergency room, she received 400 cc of normal saline. on arrival, her blood pressure was 215/131. the patient became hypoxic with an oxygen saturation of 80% and a respiratory rate of 20. a respiratory rate dropped to 26 and became agonal. attempts to bag the patient with ambi bag, but ventilation was ineffective secondary to no cuff in the trachea. in the emergency room, the tracheostomy was attempted to be removed; however, this was unsuccessful. it had never been removed in the past nine years. breathing was shallow and rapid. white blood cell count was 36.2. a chest x-ray revealed no infiltrates seen. an arterial blood gas was drawn and revealed ph was 7.19, co2 was 88, and oxygen was 106. the patient's tracheostomy was attached to the ventilation, and on ventilation the arterial blood gas improved to a ph of 7.36, co2 of 50, and oxygen of 318; however, her blood pressure dropped to the 70s with no response to wide-open fluids. peripheral neo-synephrine was then started, and right subclavian catheter was placed. the subclavian catheter actually went up the left internal jugular, and so had to be changed over wire, and is currently correctly positioned. subsequently, the neo-synephrine was then re-routed to go through the central venous access. an arterial line was placed on the day of admission as well. physical examination on presentation: physical examination revealed temperature was 102.6, blood pressure was 157/115, heart rate was 97, respiratory rate was 19, and oxygen saturation was 70%. in general, the patient was trached and not responding; however, the family reports this was the patient's bowel sounds. head, eyes, ears, nose, and throat examination revealed the mucous membranes were moist. a cut on the tongue. the neck examination revealed a tracheostomy with no erythema or exudate. cardiovascular examination revealed tachycardia. no murmurs or rubs. otherwise, a regular rhythm. lung examination revealed very shallow quick breaths and a few scattered bronchial sounds. the abdomen revealed good bowel sounds and was soft. distended and tympanic. the family reports this was the patient's baseline. extremity examination revealed extremities were warm. no decubitus ulcerations. no spontaneous movement of extremities except eyes closing. pertinent laboratory values on presentation: white blood cell count was 36.2, hematocrit was 44.4, and platelets were 562. electrolytes revealed sodium was 131, potassium was 4.6, chloride was 91, bicarbonate was 31, blood urea nitrogen was 16, creatinine was 0.6, and blood glucose was 155. urinalysis revealed large amounts of blood, 500 mg/dl of protein, and moderate leukocytes, more than 50 red blood cells, more than 50 white blood cells, a few bacteria, and no yeast. microbiology history: in , there was a urine cultures which grew out pseudomonas which was sensitive to everything but ciprofloxacin (which it was resistant to). it also grew out pan-sensitive enterococcus. in , urine culture grew out pan-sensitive enterococcus. in , urine culture grew out ampicillin-resistant escherichia coli, cefuroxime intermediate and pseudomonas resistant to ciprofloxacin. pertinent radiology/imaging: a chest x-ray revealed a left lower lobe streak ?. electrocardiogram revealed no acute st-t wave changes per baseline. hospital course by issue/system: 1. hypotension issues: hypotension most likely due to urosepsis with a urinalysis showing a high white blood cells and moderate leukocyte esterase with a white blood cell count of 36.2. the patient was started on phenylephrine drip on the day of admission () which was discontinued later on during the day due to resolving hypotension. 2. urosepsis issues: the patient was started on ceftazidime 2 g intravenously q.8h. and metronidazole 500 mg intravenously q.8h. urinalysis showed signs of urinary tract infection. urine culture from the grew out enterococcus pan-sensitive to ampicillin, levofloxacin, and vancomycin. the patient was originally started on vancomycin to treat enterococcus until these sensitivities came back from enterococcus being sensitive to ampicillin. thus, vancomycin was discontinued on and ampicillin was started. urosepsis resolving, and the patient was afebrile throughout her hospital course. white blood cell count dropped to 13.4. there was a question of a fistula in the urinary system; however, urology was consulted and upon the methylene blue study there was found to be no vesicovaginal fistula. additionally, clostridium difficile was negative times two; taken from stool cultures. the patient received a computed tomography of the abdomen and pelvis with and without contrast which did not show any signs of free fluid or abscess collection. 3. respiratory failure issues: the patient was ventilated on and and was then able to be weaned from the ventilator, and is currently saturating well on an fio2 of 50% through her tracheostomy. the patient went to the operating room on for a trachea change. a new tracheostomy was put in place, and the old tracheostomy was removed. additionally, sputum from grew out pseudomonas sensitive to everything but ciprofloxacin. thus, ceftazidime was to be continued to complete a 14-day course. the patient received a computed tomography of the trachea without contrast and with reconstruction prior to going to the operating room for tracheostomy removal and replacement with a new tracheostomy. 4. multiple sclerosis issues: the patient was to continue baclofen. 5. anemia issues: the patient's hematocrit was 44.4 on admission and dropped to 34.8 on the same day of admission; progressively decreasing to 31.7 on . no signs of active bleeding. negative hemolysis laboratories. most likely due to blood draws. 6. hyponatremia issues: the patient's sodium decreased from 133 on admission to dip down to 126 on , but then increased back up to 132 on . this was most likely due to hypovolemia as the patient's sodium level responded to intravenous infusion of normal saline. other electrolytes were repleted as needed; such as phosphate and magnesium. the patient without to resume tube feeds with promod with fiber. 7. prophylaxis issues: the patient received prophylactic care of h2 blockers, subcutaneous heparin, and pneumo boots. 8. code status: the patient is full code, and communication was kept with the husband who visited frequently. 9. access issues: the patient will also need intravenous access for continuation of antibiotics at home for the enterococcus in the urine and the pseudomonas in the sputum (i.e. the tracheobronchitis). the patient was to be evaluated today for a peripherally inserted central catheter placement to complete a 14-day course of ampicillin for enterococcus and ceftazidime for pseudomonas. condition at discharge: condition on discharge was good. discharge status: the patient was to be discharged after peripherally inserted central catheter line placement. discharge diagnoses: 1. respiratory distress with urosepsis enterococcus. 2. tracheobronchitis pseudomonas. surgical interventions: tracheostomy tube changed in the operating room on . medications on discharge: 1. ceftazidime 2 g intravenously q.8h. (for nine days). 2. ampicillin 1 g intravenously q.6h. (for eleven days). the patient was to continue all her home medications; which i have verified with her home nurse that she has refills of these medications at home. discharge instructions/followup: the patient was to follow up with her primary care physician as needed. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other genitourinary instillation revision of tracheostomy removal of impacted feces diagnoses: urinary tract infection, site not specified unspecified septicemia hyposmolality and/or hyponatremia acute and chronic respiratory failure multiple sclerosis infection of tracheostomy mechanical complication of tracheostomy other impaction of intestine 

Answer: The patient is high likely exposed to