Review Question - QID 214290

A 27-year-old woman is admitted to the hospital after a suicide attempt. She cut her throat and her wrists with a knife. Her wounds appear to be grossly contaminated. The patient is altered on arrival, intubated, and transferred to the ICU for further care. She has a history of depression and multiple hospitalizations with a recent hospitalization after an attempted overdose. On day 2 of her stay, she is extubated and is doing well. She is currently being given her home medications and is being monitored closely. Her temperature is 97.6°F (36.4°C), blood pressure is 111/74 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Inspection of her wrists demonstrates some purulence and surrounding erythema. The patient has multiple medication allergies, and she is treated for her infection. Two days later, the patient appears more confused and irritable than before. She is sweaty, her pupils are dilated, and she demonstrates hyperreflexia. Which of the following is the most likely etiology of this patient's symptoms?