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: epidural abscess major surgical or invasive procedure: l2/3 partial laminectomy and l5 laminectomy for epidural abscess washout history of present illness: patient is a 57 year old woman with history of ivdu, hypertension, hypothyroidism, anxiety and depression who was transferred from osh after being found to have an epidural abscess. she had presented there with back pain on the r side x 2-3 days, which was not relieved by flexeril. pt is poor historian and unable to provide much detail other than she was having back pain. pt did deny fever/chills at home and bowel/bladder incontinence. laboratories at this osh revealed a creatinine of 2.1 (from baseline of 1) and elevated esr of 105. mri spine was performed and revealed abscess at l2-l3 level with phlegmon l4-l5-s1, no cord compression. blood cultures from from osh grew gram negative rods, which were pan-sensitive and gram positve cocci. . she was transferred on to and underwent laminectomy and washout of l2, l3, and l5 with epidural drain placement. past medical history: 1) intravenous drug use: cocaine, reported last use 1-2 weeks age 2) hypertension 3) hypothyroidism 4) anxiety 5) depression 6) h/o iron deficiency anemia 2 years ago, requiring transfusions adn weekly iron infusions x3mo 7) status post r knee surgery for oa, torn meniscus, 8) status post l ankle surgery with pin placement for fracture, 9) status post cholecystectomy, 10) c-section, social history: pt lives with her husband and is his caretaker as he is a double amputee. pt has a daughter. pt denies tobacco and etoh use. family history: unknown cancer in father; chf, atherosclerosis, and neuropathy in mother. physical exam: t99.4, bp 126/77, p84, r18, o2sat 95%, bs 163 gen: nad, obsese heent: nc/at, conjunctiva clear, mmm chest: ctab cor: rrr, nl s1/s2, no murmur abdomen: +bs, soft, mildly tender in llq, nontender ext: trace pedal edema. neuro: alert and oriented x3, muscle strength 5/5 in ues and les pertinent results: admission labs: . 05:50am wbc-8.8 rbc-3.66* hgb-9.0* hct-26.6* mcv-73* mch-24.7* mchc-34.0 rdw-15.9* 05:50am neuts-84.9* lymphs-10.0* monos-4.1 eos-1.0 basos-0.1 05:50am glucose-114* urea n-28* creat-1.4* sodium-135 potassium-4.8 chloride-98 total co2-26 anion gap-16 . imaging: . 9:45 pm lumbar sp,single film in o.r. findings: no comparisons. a series of two intraoperative lateral radiographs of the lumbar spine were obtained without a radiologist present. these demonstrate radiopaque probes posteriorly. assuming that the lowest movable disc represents l5-s1, the probe is located posterior to the l3 vertebral body. retractors are seen posteriorly. please refer to operative report for full details. . 8:04 am mr w & w/o contrast; mr w &w/o contrast impression: overall, examination slightly limited secondary to patient motion. 1. ventrally located epidural process along the l2 and l3 vertebral bodies with mild associated mass effect, likely a combination of phelgmon and abscess. 2. enhancing mass located intradurally along the posterior aspect at the l4, l5 and s1 levels with appearance suggestive of inflammatory - infectious change/phlegmon. . echo conclusions: the left atrium is moderately dilated. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. 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. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. brief hospital course: post-operatively the patient was persistently agitated and required frequent doses of iv ativan and dilaudid. she had pulled out several of her iv lines. she remained afebrile and other than mild tachycardia was hemodynamically stable. given concern for substance abuse withdrawal and poor mental status in setting of known bacteremia, the patient was transferred to the micu. in the micu, she was on pca and ciwa scale with standing valium for the first 4 days of micu stay. the ciwa scale was discontinued on when the patient become somnolent. upon resolution of mental status changes, pt was transferred to the floor on . . 1. epidural abscess/bacteremia: blood cultures from showed gram (-) rods and grew s. marcescens. subsequent serial blood cultures were negative. pt was evaluated and followed by id. it was felt that the source of her infection was likely related to ivdu. there was a question of endocarditis as the source for seeding; however, there was no notable murmur on exam and a tte failed to show any valvular abnormalities. ekg did not show any abnormalities. pt was discharged on ciprofloxacin iv for 6 weeks as recommended by id. she will have to see the infectious disease doctors and appointment has been scheduled for a follow up. . 2. substance abuse, cocaine: pt was referred to social work. . 3. anemia, microcytic: pt had no sign of active bleed. iron studies appeared to be c/w anemia of chronic disease. hct remained stable after 1 unit of prbcs on . . 4. hypertension: pt on home medications. . 5. hypothyroidism: pt on home medication. . 6. depression: pt on home medication. . 7. hyperglycemia/dm ii (newly diagnosed): pt on insulin ss. will need further work up as an outpatient. medications on admission: 1) amitryptaline 25 mg daily 2) lorazepam 1 mg twice daily 3) alprazolam 1 mg twice daily 4) celexa 40 mg daily 5) hydrochlorothiazide 25 mg daily 6) levothyroxine 100 mcg daily 7) senna 8) colace 9) vancomycin 1 gram day discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 6. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 7. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 9. insulin sliding scale please see attached insulin sliding scale 10. oxycodone 10 mg tablet sustained release 12 hr sig: three (3) tablet sustained release 12 hr po q12h (every 12 hours). 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 13. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 14. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 15. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 16. ciprofloxacin 400 mg/40 ml solution sig: one (1) intravenous q 8h (every 8 hours) for 5 weeks. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. l2-l5 serratia epidural abscess. 2. serratia bacteremia. 3. acute renal failure. 4. polysubstance abuse - ivdu cocaine. . secondary: 1. hypertension. 2. iron deficiency anemia. 3. hypothyroidism. 4. anxiety - depression. 5. obesity. 6. s/p cholecystectomy 7. diabetes discharge condition: neurologically stable discharge instructions: please keep wound(s) clean and dry / no tub baths or pools for two weeks from your date of surgery . if you have steri-strips in place ?????? keep dry x 72 hours. do not pull them off. they will fall off on their own or be taken off in the office . no pulling up, lifting> 10 lbs., excessive bending or twisting . limit your use of stairs to 2-3 times per day . have a family member check your incision daily for signs of infection . if you are required to wear one, wear cervical collar or back brace as instructed . you may shower briefly without the collar / back brace unless instructed otherwise . take pain medication as instructed; you may find it best if taken in the a.m. when you wake for morning stiffness and before bed for sleeping discomfort . increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation . clearance to drive and return to work will be addressed at your post-operative office visit call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine ?????? any weakness, numbness, tingling in your extremities ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f ?????? any change in your bowel or bladder habits remove drain when less than 30 cc per 8 hour shift remove staples/sutures in 10 days . you have a new diagnosis of diabetes and you are on insulin. please follow up with your primary care physician for further management of diabetes. followup instructions: infectious diease provider: . phone: date/time: 9:00 . neurosurgery provider: . please come to your appointment on at 3:15. the clinic is located at 110 , , . procedure: other exploration and decompression of spinal canal diagnoses: anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism dysthymic disorder bacteremia morbid obesity intraspinal abscess drug withdrawal cocaine abuse, continuous other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to