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: patient recorded as having no known allergies to drugs attending: chief complaint: sepsis major surgical or invasive procedure: ercp with pancreatic and biliary stent placement () ercp with pancreatic and biliary stent placement ( and ) intubation (, ) central venous line placement hd catheter placement ir-guided drainage of hepatic fluid collection () ir-guided drainage of hepatic fluid collection () history of present illness: ms. is a 68-year-old woman female with a h/o cad, s/p mi, who presented on at with abdominal pain, for which she underwent emergent lap cholecystectomy. she developed hypotension and sepsis and was transferred to for ercp and critical care. past medical history: cad s/p mi with pci depression schizoaffective d/o dementia bipolar d/o delusional d/o oa gerd htn social history: lives in rehab and nursing center. has sister as caregiver. : () and (), sisters; son. no current etoh, although history of heavy abuse 2 ppd tobacco x many years no illicits family history: son with schizoaffective disorder physical exam: vital signs: 99.7 118 107/61 12 98% on 100%fio2, ac 400/20 peep 10 . physical exam general: intubated, sedated heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, tachy. normal s1, s2. no murmurs, rubs or . jvp=difficult to appreciate rij and neck size lungs: ctab, good air movement biaterally anteriorly. abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. blue discoloration of toes bilaterally skin: no rashes/lesions, ecchymoses. neuro: intubated, sedation, opened eyes with movement and spontaneous movement in les. pertinent results: admission labs: 07:31pm wbc-41.3* rbc-3.64* hgb-10.7* hct-33.1* mcv-91 mch-29.5 mchc-32.5 rdw-14.9 07:31pm neuts-79* bands-16* lymphs-2* monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 07:31pm plt smr-normal plt count-180 07:31pm glucose-108* urea n-43* creat-2.8* sodium-145 potassium-4.0 chloride-106 total co2-21* anion gap-22* 07:31pm calcium-6.3* phosphate-5.3* magnesium-2.3 07:31pm alt(sgpt)-517* ast(sgot)-937* ld(ldh)-982* ck(cpk)-* alk phos-185* tot bili-6.2* 07:31pm ck-mb-60* mb indx-0.4 ctropnt-0.14* 07:49pm lactate-4.6* . ct abdomen/pelvis : interval development of 2.5cm rounded, hypodense fluid collection in the anterior aspect of the left hepatic lobe, concerning for abscess especially in the context of sepsis. the abscess is amenable to ultrasound-guided bedside drainage. . ct abdomen/pelvis : 1. abnormal bowel in the mid to lower abdomen with associated mesenteric edema is worrisome for ischemic bowel and may be secondary to poor perfusion or infectious etiologies. the proximal aspects of the sma are grossly patent. 2. dilated fluid filled appendix likely reflecting appendicitis in the proper clinical context unchanged compared to most recent ct. 3. stable intrahepatic abscess with focus of air. 4. unchanged fluid within the gallbladder fossa tracking in a subcapsular location along the posterior inferior right hepatic lobe for which biliary leakage cannot be excluded given the recent cholecystectomy. . ct abdomen/pelvis : 1. moderate proximal small bowel dilatation with a conglomerate of small bowel in the mid abdomen, surrounded by mesenteric fat stranding. findings indicate a small-bowel obstruction possibly the result of an nternal hernia. 2. hypodense hepatic lesion has minimally decreased in size. 3. small bilateral pleural effusions. . kub : an ng tube terminates in the proximal stomach. an internal biliary stent is again noted. residual contrast is seen in the large bowel. no significantly dilated small bowel loops are identified. no pneumoperitoneum is detected. the study is limited due to the overlying soft tissues. . ercp : impression: multiple metallic clips denote prior history of cholecystectomy. a nasogastric and nasointestinal tube are seen. there is a plastic biliary stent, which is subsequently removed. cannulation of the biliary duct is successful and contrast medium injection results in complete opacification of the biliary tree. mild dilatation of the cbd is seen. multiple filling defects are present, attributed to sludge on the ercp report. a small amount of contrast spillage is seen at the area of cholecystectomy clips (image 16), suggestive of a bile leak. a new biliary stent is placed. for further details, please refer to the full ercp report in omr. small bowel follow through: 1. no evidence of enteroenteric fistula. 2. persistent loops of dilated small bowel with delayed contrast passage into non-dilated distal small bowel and colon, compatible with a partial small- bowel obstruction. . brief hospital course: . #. septic shock secondary to cholecystitis: patient grew e. coli and vre in osh blood cultures as well as e. coli, vre, and kluyveria cryocresan (enterobacteriacae) in bile culture. blood cultures on admission here grew vre; subsequent cultures were negative until when one bottle of two blood cultures grew gram positive cocci in pairs/clusters. in the setting of her low-grade temperatures and line change after the blood cultures were drawn, plan was to continue treating through her lines and monitor closely. her antibiotics were initially tailored to linezolid, ctx, and flagyl to complete 14-day course. given persistent temperatures, patient was broadened to meropenem and continued on linezolid beyond 14 days, in discussions with id. ercp on revealed normal biliary tree on limited cholangiogram (biliary stent placed), normal limited pancreatogram (pancreatic duct stent paced, and diffuse ulcerations of the fundus, stomach body and antrum - differential diagnosis includes stress ulcers and ischemia). during repeat ercp on , pancreatic stent was removed and biliary stent re-placed. surgery was also consulted and followed. she initially required aggressive ivf resuscitation and levophed, which was weaned off on . she needs repeat ercp 10 weeks initially stent placements on for removal of biliary stent. also, ct abdomen and pelvis on showed a liver abscess that was aspirated with good effect - given interval improvement in abscess size on antibiotics, ir did not feel further drainage of the abscess was necessary. liver abscess cultures grew out vre that was treated with extensive course of linezolid. patient continued to fevers during her hospitalization. urine cultures also subsequently grew out albicans (presumptive identification) and patient's beta-glucan climbed from 40 to 375 to 500. patient was started on micafungin for possible fungal infection in setting of high-dose, prolonged antibiotic courses, and then switched to fluconazole. . on she went to ercp for concern for biliary stent infection or obstruction. the ercp was concerning for bile leak. the old stent was removed and a new stent was placed. on repeat abdominal ultrasound, there was no drainable fluid collection and she also had a small bowel follow through on that did not show any entero-enteric fistula, but did show a possible sbo v. ileus as the contrast media took a long time to pass through. on patient's symptoms of obstruction progressed. her urine output declined and she became hypotensive. she was transferred to the icu where she was started on multiple pressors. her abdomen became distended and she required intubation. she was rapidly deteriorating despite aggressive medical management. the surgical service and patient's family were notified. the decision was made not to undergo surgical intervention. the family was called in to the icu. the family requested comfort measures only. pressors were withdrawn and patient expired shortly after. the family requested autopsy be performed. . # abdominal distension, ileus: developed shortly after extubation, with significant ng tube output. ct abdomen/pelvis initially concerning for appendicitis, bowel ischemia; in discussions with transplant surgery, however, it was felt that conservative management would be sufficient. repeat ct abdomen/pelvis concerning for obstruction but oral contrast could be seen in rectum and patient started stooling consistently afterwards. patient's wbc, fevers, abdominal exam, lactate were all monitored closely and remained stable. patient's alkaline phosphatase did continue to climb and peaked on , but felt likely due in part to tpn. patient was switched to post-pyloric dobbhoff tube feeds with good effect. she was initially on linezolid/ceftriaxone/flagyl. with continued fevers and concerning abdominal exams, she was broadened to meropenem/linezolid. on monday, , given concerns of serotonin syndrome on linezolid, patient was switched to daptomycin. . id followed the patient closely and she eventually was maintained on a course of antibiotics including meropenem, daptomycin, fluconazole, and flagyl. . # cholecystitis, calculous: as above. lfts trended down during the hospitalization. she had a jp drain that was pulled . surgery continued to follow however surgical intervention was not recommended. . #. hypoxic respiratory failure: pt arrived intubated. cxr was significant for mild pulmonary edema and small bilateral pleural effusions with atelectasis. she was extubated from the ventilator on . upon transfer to the mi cu, patient required re-intubation. she was eventually extubated but continued to have episodes of tachypnea felt likely secondary to anxiety and mild volume depletion. she was treated with ativan and dilaudid --> transitioned to just dilaudid and small ivf boluses with good effect. patient also had continued bilateral chest pt and nebulizers regularly. given a intermittent harsh, stridor-like breathing (but no respiratory distress - abgs/cxrs all within normal limits during these episodes), ent saw patient and visualized the vocal cords via laryngoscopy, which were within normal limits. patient was continued on humidified face mask/face shovel, aspiration precautions and ppi. her respiratory status remained stable and as of , she was on 2l nc. . #. acute on chronic renal failure: this was felt to be atn vs. myoglobinuria. she required cvvh starting and was transitioned to hd on . renal service followed and felt that patient's kidneys would not recover function permanently. eventually, tunnelled hemodialysis line was placed with plans for long-term hemodialysis management of patient's fluid status. patient was also started on epogen with hemodialysis for low hematocrits (22-24). she was intermittently transfused to keep hct>24. she was found to have a thrombus at her hd line site, however due to the fact that removing this would create a very limited access situation, the line remained in place and she underwent dialysis mwf. she was found to be making only a scant amount of urine per day and as a result, her foley was removed for about 1 week until when her bladder was noted to be distended and she was cathed for 700cc of urine. foley was left in place to determine possible improvement in her urine output. . #. acute mental status changes: pt required prolonged intubation due to depressed mental status. head ct showed no acute pathology. this was likely toxic/metabolic, including use of sedatives in the setting of hepatic and renal failure. with cvvh and time off sedatives, her mental status improved greatly by extubation and continued to improve gradually. in discussions with psychiatry, patient's psychiatric medications were held for concern of serotonin syndrome with her ssri and linezolid, and generally critical medical condition. family has also expressed concern that patient was over-medicated prior to this hospitalization. after she was discontinued on linezolid therapy, her celexa was restarted at 10mg per day. in collaboration with the psych team, they recommended no further escalation in her psych meds at this point. . #. erythema multiforme and other skin changes: it was unclear which antibiotic this was due to. it improved without changes in abx regimen. patient also developed skin breakdown in the coccyx area (deep tissue injury) and macerated rash on gluteal folds/buttocks which improved with continued miconazole and lotrisone cream per wound care recs. . # infected incision site: upon removal of staples, patient supraumbilical surgical wound dehisced and developed slightly purulent/necrotic edge appearance. surgery debrided and packed incision site and recommended twice daily wet to dry dressings to which patient responded well. . # ischemic digits: pt was found to have purple discoloration of her toes. this was likely due to pressor use and remained stable throughout her hospitalization. medications on admission: ativan 2mg iv q6 prn combivent q4 fentanyl drip flagyl heparin sc nexium iv 40 zosyn 2.25g gentamicin 360 mg pridex q 8 pitressin 0.04u/min discharge medications: none discharge disposition: expired discharge diagnosis: sepsis cholecystitis small bowel obstruction bowel perforation hypoxic respiratory failure discharge condition: patient expired discharge instructions: patient expired followup instructions: patient expired 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 hemodialysis venous catheterization for renal dialysis endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy other bronchoscopy endoscopic insertion of stent (tube) into bile duct removal of t-tube, other bile duct tube, or liver tube percutaneous aspiration of liver injection or infusion of oxazolidinone class of antibiotics diagnoses: acidosis coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) severe sepsis candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified acute respiratory failure septic shock abscess of liver acute myocardial infarction of other inferior wall, initial episode of care pressure ulcer, lower back septicemia due to escherichia coli [e. coli] cholangitis other and unspecified coagulation defects diastolic heart failure, unspecified unspecified intestinal obstruction calculus of bile duct with acute cholecystitis, without mention of obstruction pressure ulcer, unstageable acute venous embolism and thrombosis of subclavian veins 

Answer: The patient is high likely exposed to