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: abdominal pain major surgical or invasive procedure: exploratory laparotomy placement of 16mm dacron aortic tube graft placement of pa catheter percutaneous tracheostomy bronchoscopy endoscopy history of present illness: 65f with known infrarenal aaa who presents with 4 days of worsening left lower quadrant abdominal pain, radiating to her back & down legs. she denied any fevers, chills, nausea, vomiting, prior episodes, urinary or bowel symptoms. no prior episodes. past medical history: cad s/p cabg a fib htn dm2 s/p c section x3 ventral hernia social history: +cigs, smokes 1 ppd lives with husband, , in , ma daughter is health care proxy () family history: noncontrib physical exam: afeb, vss aox3, nad rrr, no bruits cta bilat soft obese llq>rlq ttp (no rebound), no cvat, guaiac neg pulses: palp throughout pertinent results: see carevue for specific results. * * * --radiology-- ct abd w&w/o c 9:47 pm ct abd w&w/o c; ct pelvis w&w/o c reason: please eval aaa size, rupture; please also evaluate for kidn field of view: 42 contrast: optiray medical condition: 65 year old woman with abdominal pain radiating to back, says she has a known aaa (?size); i suspect renal stone reason for this examination: please eval aaa size, rupture; please also evaluate for kidney stones contraindications for iv contrast: none. indication: 65-year-old woman with abdominal pain radiating to back. no abdominal aortic aneurysm. technique: contiguous axial ct images of the abdomen and pelvis were obtained with and without the administration of iv contrast , with cta technique. no comparison. findings: note is made of 5.3-cm infrarenal abdominal aortic aneurysm with mural thrombus, surrounded by hyperdense fat stranding and soft tissue measuring up to 46 , most likely representing abdominal aortic aneurysm with impending rupture. no definite abscess is identified, however, the possibility of infection cannot be totally excluded. celiac, sma, and iliac vessels are patent. no evidence of active extravasation is noted. left kidney is atrophic, with very small left renal artery. right kidney is unremarkable. note is made of fatty liver. no focal liver lesion. the bladder, spleen, pancreas, adrenal glands, and the visualized portions of large and small intestines are within normal limits. no lymphadenopathy. pelvis: note is made of sigmoid diverticulosis. otherwise, the visualized portions of the small intestines are within normal limits. no ascites. no lymphadenopathy. in the visualized portion of the chest, note is made of coronary artery calcification in this patient who is status post cabg. note is made of 5-mm noncalcified pulmonary nodule in the left lower lobe, which needs to be followed in three months. note is made of atherosclerotic disease of the thoracoabdominal aorta. there is no suspicious lytic or blastic lesion in skeletal structures. impression: 1. 5.3-cm infrarenal abdominal aortic aneurysm with mural thrombus, surrounded by hyperdense soft tissue and fat stranding suggestive of impending rupture with hematoma. no definite abscess is identified, however, superimposed infection cannot be totally excluded. no evidence of active extravasation. 2. sigmoid diverticulosis. 3. fatty liver. 4. 5-mm noncalcified pulmonary nodule in left lower lobe. please follow in three months. the information was discussed with the ed physicians and surgery resident, including dr. in person at the time of examination, and it was also flagged to ed dashboard. the study and the report were reviewed by the staff radiologist. dr. dr. approved: wed 7:51 am post-pyloric feeding tube placement under fluoroscopic guidance: a 120 cm 8 french - feeding tube was inserted into the fourth portion of the duodenum under fluoroscopic guidance. the position was confirmed by injection of approximately 10 cc of gastrografin. no immediate complications were seen. impression: successful post-pyloric feeding tube placement. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 6:29 pm procedure date: * * * --microbiology-- 11:17 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): budding yeast. respiratory culture (final ): oropharyngeal flora absent. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. yeast. sparse growth. serratia marcescens. sparse growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. gram negative rod(s). sparse growth. gram negative rod #3. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ serratia marcescens | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin---------- 1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s fungal culture (preliminary): yeast. 10:56 am mrsa screen site: rectal source: rectal swab. **final report ** mrsa screen (final ): no staphylococcus aureus isolated. 10:56 am swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): enterococcus sp.. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r linezolid------------- 2 s penicillin------------ =>64 r vancomycin------------ =>32 r * * * ekg , s.: ecg detail - ccc record # electrocardiogram performed on: 18:12:04 the rhythm is likely sinus with a-v conduction delay. p-r interval 0.22. there is much baseline artifact. right bundle-branch block. low precordial lead voltage. compared to the previous tracing of no diagnostic interim change. read by: , intervals axes rate pr qrs qt/qtc p qrs t 49 0 138 446/426 0 23 132 brief hospital course: after being diagnosed in the er with a rupturing aaa, ms was rapidly consented for ex lap & brought emergently to the or by the vascular team. please refer to the previosuly dictated op note from by dr. for procedure details. she was then transferred to the surgical icu, where she remained for 23 days. this extended icu course can be summarized in an organ systems based approach. neuro: her pain was controlled with fentanyl drips & she was sedated with propofol during her intubation. she moved all extremities soon after surgery & was interactive, although nonverbal bc of her tracheostomy, at the time of discharge. her pain/sedation regimen currently consists of a fentanyl patch & intermittent roxicet & ativan as needed. cv: she remained hemodynamically stable before being taken to the or on . postop, she did develop rapid atrial fibrillation, which was controlled with amiodarone and beta blockade. later postop, she had signficant hypertension & with the assistance of cardiology, was placed regimen of prazosin, clonidine, norvasc & intermittent hydralazine. resp: she developed a postoperative vent-associated pneumonia (serratia), which was successfully treated with 21 days of levaquin. this impaired her ability to vean from the ventilator & on , she was taken to the or by thoracic surgery for a percutaneous tracheostomy. she has developed significant coughing episodes when suctioned via her tracheostomy. fen: she was maredly fluid requiring postop, ultimately reaching about 15kg above her baseline weight (92kg). after treating her penumonia, she was successfully diuresed back to 95kg at the time of discharge. her creatinine only developed a small rise to 2.0 from postoperative atn, but normalized to 1.2 at the time of dc. gi: she had a prolonged postoperative ileus & required tpn to sustain her during this time. she was transitioned over to novasource tube feeds once her gi tract was functional. she is currently tolerating tube feedings at a goal rate of 45cc/hr. heme: she is prophylaxed against dvts with tid sq heparin. her current hematocrit is 28. she required multiple transfusions for her blood loss anemia. id: pneumonia as above. she also was noted to be vre by rectal swab on . endo: her perioperative blood glucose was tightly controlled via insulin gtt & then sliding scale. prior to dc, an attempt to restart her oral hypoglycemics resulted in hypoglycemia. she is controlled currently on just sliding scale. medications on admission: coumadin 5/7.5 (a fib) aspirin lopressor norvasc enalapril glyburide glucophage lipitor discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 4. therapeutic multivitamin liquid sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 5. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). disp:*qs container* refills:*2* 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). disp:*qs container* refills:*2* 7. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qsat (every saturday). disp:*5 patch weekly(s)* refills:*2* 8. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. prazosin 5 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 10. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 11. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). disp:*10 patch 72hr(s)* refills:*2* 12. lansoprazole 30 mg susp,delayed release for recon sig: one (1) dose po daily (daily): 30mg pgt qd. disp:*30 dose* refills:*2* 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). disp:*90 ml* refills:*2* 14. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheeze. disp:*1 inhaler* refills:*5* 15. nystatin 100,000 unit/g ointment sig: one (1) appl topical qid (4 times a day) as needed. disp:*qs containter* refills:*0* 16. docusate sodium 150 mg/15 ml liquid sig: two (2) teaspoons po bid (2 times a day). disp:*120 teaspoons* refills:*2* 17. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day) as needed for constipation. disp:*30 suppository(s)* refills:*0* 18. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid sig: five (5) ml po q6h (every 6 hours) as needed for cough. disp:*250 ml(s)* refills:*0* 19. insulin regular human 100 unit/ml solution sig: one (1) dose injection every six (6) hours: follow attached sliding scale. disp:*qs ml* refills:*2* 20. hydralazine 20 mg/ml solution sig: one (1) ml injection q4-6h (every 4 to 6 hours) as needed for breakthrough sbp > 160. disp:*50 ml* refills:*0* 21. ativan 1 mg tablet sig: 1-2 tablets po three times a day as needed for anxiety. disp:*30 tablet(s)* refills:*0* 22. roxicet 5-325 mg/5 ml solution sig: teaspoons po every six (6) hours as needed for pain. disp:*250 ml* refills:*0* discharge disposition: extended care facility: northeast - discharge diagnosis: hypertension cad s/p cabg atrial fibrillation type 2 diabetes, controlled ruptured aaa hyperalimentation/tpn vent associated pneumonia postoperative ileus blood loss anemia acute renal failure acute tubular necrosis discharge condition: improved discharge instructions: tube feeds via dobhoff as tolerated. contact your md if you develop fevers>101, redness or drainage about your wound, or if you have any questions or concerns. followup instructions: contact dr. office at to arrange a follow up appointment in about 1 month. procedure: venous catheterization, not elsewhere classified other gastroscopy enteral infusion of concentrated nutritional substances other electric countershock of heart other intubation of respiratory tract other intubation of respiratory tract temporary tracheostomy resection of vessel with replacement, aorta, abdominal transfusion of packed cells transfusion of other serum endarterectomy, aorta perioperative autologous transfusion of whole blood or blood components other nonoperative respiratory measurements procedure on single vessel diagnoses: pneumonia due to other gram-negative bacteria tobacco use disorder acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atherosclerosis of aorta atrial fibrillation aortocoronary bypass status infection with microorganisms without mention of resistance to multiple drugs paralytic ileus abdominal aneurysm, ruptured 

Answer: The patient is high likely exposed to