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: no known allergies / adverse drug reactions attending: chief complaint: decreased responsiveness major or invasive procedure: femoral central line history of present illness: 65m with pmhx of cva (nonverbal and does not move his arms or legs at baseline), afib on coumadin, multiple pneumonias (s/p trach/peg ), multiple uti/urosepsis with proteus sensitive to cefepime/ceftriaxone/meropenem, esbl klebsiella sensitive to cipro/meropenem/zosyn, c diff s/p colectomy, type 2 diabetes mellitus, peripheral vascular disease. patient presents from found today with sats 80s and not responding to commands, not nodding. baseline non-verbal, but will nod to questions. in ed, bps dipped to high 80s, low 90s. patient with a trach, seems to have a cuff , need to be changed out. ua positive. given cefepime and vanco. trop may be demand. given 2l ns. on transfer, vs: 85 95/52 16 100% trach mask. on arrival to the icu, hr 73, bp 87/53, rr 11, 93% trach mask. patient unresponsive, not moving extremities. review of systems: unable to obtain, patient unresponsive past medical history: * hypertension * hypothyroidism * h/o cva (bilateral embolic cerebellar , hemorrhagic left thalamic ) * type ii diabetes mellitus * peripheral neuropathy * depression * h/o dvt (? - no records) * atrial fibrillation (on coumadin) * peripheral vascular disease * hyperlipidemia * anemia of chronic disease * tracheostomy and gj tube for chronic aspiration () - portex bivono, size 6.0 * c.diff colitis in requiring total abdominal colectomy with end ileostomy , repeat positive c diff toxin (outside facility, here) social history: prior resident of , now at nursing home. family very involved in care. patient does not take anything by mouth due to history of aspiration. spanish-speaking. patient is a former 60 pack year smoker but quit in . family history: patient has a mother with diabetes and brother with heart disease. physical exam: admission exam: vitals: hr 73, bp 87/53, rr 11, 93% trach mask general: unresponsive, no respiratory distress. no facial expression, not moving extremities heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: diffuse rhonchi from anterior lung fields. no crackles. cv: rrr, 2/6 systolic ejection murmur. no rubs, gallops abdomen: soft, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining purulent urine ext: cold, not well perfused, slow cap refill. b/l hands and feet contracted. no cyanosis or edema discharge exam: vitals: hr 84 bp 128/72 97% trach mask gen: nodding to questions gu: foley draining clear urine ext: warm and well perfused exam otherwise unchanged pertinent results: 07:45pm blood wbc-21.5*# rbc-6.16 hgb-13.5* hct-43.8 mcv-71* mch-21.9* mchc-30.8* rdw-16.8* plt ct-213 07:45pm blood neuts-86.9* lymphs-7.5* monos-4.4 eos-1.0 baso-0.1 07:45pm blood pt-22.3* ptt-30.1 inr(pt)-2.1* 07:45pm blood glucose-171* urean-47* creat-2.0*# na-137 k-6.4* cl-97 hco3-27 angap-19 07:45pm blood alt-33 ast-62* alkphos-88 totbili-0.8 07:45pm blood lipase-32 07:45pm blood ctropnt-0.13* 07:50pm blood glucose-160* lactate-3.5* na-142 k-5.3* cl-98 calhco3-29 microbiology: blood culture x2 ()- pending, ngtd urine culture ()- preliminary, pending final proteus mirabilis. >100,000 organisms/ml.. presumptive identification. sputum culture ()- gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. 1+ (<1 per 1000x field): gram positive rod(s). respiratory culture (final ): moderate growth commensal respiratory flora. gram negative rod(s). sparse growth. of three colonial morphologies. gram negative rod(s). rare growth. stool culture ()- negative for c.difficule toxin imaging: ct head : findings: no hemorrhage, evidence of acute major vascular territorial infarction, edema, or shift of normally midline structures is present. ventricles and sulci remain mildly prominent. large arachnoid cyst in the left middle cranial fossa is stable. ica, vertebral and basilar calcifications are stable. periventricular hypodensities are consistent with small vessel ischemic changes. retained secretions are seen in the oropharynx. the visualized mastoid air cells and paranasal sinuses are well aerated. minimal thickening is seen in the anterior left ethmoid air cells. impression: no acute intracranial process. cxr : findings: portable ap upright chest radiograph is obtained. hazy opacities are new in the mid and lower lungs, which is concerning for pneumonia. no large effusion or pneumothorax is seen. cardiomediastinal silhouette appears grossly stable. impression: new hazy opacities involving the mid and lower lungs could reflect pneumonia. cxr : picc tip projecting over mid svc brief hospital course: 65m with pmhx of cva, h/o multiple pneumonias (s/p trach/peg ) with pneudomonas, multiple uti/urosepsis with proteus and esbl klebsiella, presents from with sats 80s and decreased responsiveness. # hypotension: patient initially hypotensive with sbp 80s and map 50s. hypotension due to septic shock as lactate elevated to 3.5 on presentation. given grossly dirty ua, uti was thought to be most likely source. however, with hypoxia, pneumonia and pulmonary source were also considered. patient has an extensive history of uti and pneumonia with esbl kleibsiella, and pseudomonas sensitive to cipro and gentamicin. hypovolemic hypotension possible, but patient only minimally responsive to fluid boluses. no obvious source of bleeding. hct well-above baseline, likely hemoconcentrated. in the , femoral cvl placed, and patient responded to some fluid boluses. he briefly required levophed. he was off of pressure support and not requiring fluid boluses for greater than 24 hours on the day of discharge. blood cultures showed no growth to date and urine cultures grew proteus and gram negative rods in sputum. patient was broadly covered with meropenem, cipro and vancomycin. cipro was discontinued and patient was discharged on vancomycin and meropenem with planned 8 day course (day 3 on day of discharge). a picc line was placed on for antibiotic administration. # hypoxia: o2 sat in 80s at nursing home. improved to mid 90s on trach mask. patient was treated with antibiotics as above and improved. # - patient with history of with septic episodes. given elevation bun/cr ratio, likely pre-renal etiology in the setting hypotension and hypoperfusion. cr trended down to baseline (1.0) with fluid resuscitation. # goals of care: discussed at length with family. decided to make patient dnr but ok to ventilate via trach if needed. # atrial fibrillation - ekg was consistent with sinus rhythm. coumadin initially held and inr was 3.8 on the day of discharge so was held. # sacral decubitus ulcer: granulation tissue with no exudate. two stage 2 ulcers. # hypothyroidism: stable. t4 in 10.0 (wnl). continued on home levothyroxine. # type 2 diabetes: stable. fs glucose, hiss. # peripheral neuropathy: continued home gabapentin and fentanyl patch # depression: switched duoloxetine to paxil for ng tube. continued mirtazapine. # gerd: continued lansoprazole. . transitional issues: - held warfarin at the time of discharge as inr 3.8 - meropenem and vancomycin x 8 days (final day = ) - code status: changed to dnr, ok to ventilate via trach if necessary - pending labs/studies: blood cultures x 2, final urine culture - follow-up: vancomycin trough on prior to am dose needs to be drawn medications on admission: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) nebs q6h 2. ipratropium bromide 0.02 % nebs q6h 3. baclofen 15mg po qid 4. duloxetine 30 mg capsule, delayed release(e.c.) po bid 5. fentanyl 100 mcg/hr patch q72hr 6. gabapentin 300 mg q8h 7. levothyroxine 25 mcg po daily 8. mirtazapine 15 mg po qhs 9. acetaminophen 650 mg/20.3 ml solution po q6h prn pain 10. ascorbic acid 500 mg po daily 11. miconazole nitrate 2 % powder appl topical prn skin irritation 12. senna 8.6 mg po bid prn constipation. 13. lansoprazole 30 mg tablet,rapid dissolve dr daily 14. bisacodyl 10 mg tablet po daily prn constipation. 15. ferrous sulfate 220 mg (44 mg iron)/5 ml solution po daily 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) nebs q2h prn sob 17. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension 15-30ml po qid prn stomach upset. 18. meropenem 500 mg recon soln iv q6h for 11 days (last day ) 19. docusate sodium 50 mg/5 ml liquid 10ml po qhs 20. enoxaparin 80 mg/0.8 ml subcutaneous until inr is therapeuic 21. 100 unit/ml solution 34 units qhs 22. insulin sliding scale 23. warfarin 4 mg po daily 24. acetylcysteine 20% (200 mg/ml) 1 qid 25. ipratropium bromide 0.02 % nebs q2h prn sob 26. milk of magnesia 400 mg/5 ml 30 ml po daily prn constipation 27. glucerna liquid : one (1) app po once a day: 1.2 via feeding pump at 75 ml/hr. up at 2pm down at 10am. 28. multivitamin po daily 29. novolin r 100 unit/ml solution : per sliding scale injection qac. discharge medications: 1. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 2. therapeutic multivitamin liquid : five (5) milliliters po daily (daily): gtube at 9am. 3. novolin r 100 unit/ml solution : per sliding scale injection four times a day: 6:30, aa:00, 16:00, 21:0o daily. sliding scale: 0-200 = 0 units, 201-250 = 2 units, 251-300 4 units, 301-350 = 6 units, 351-400 = 8 units, 401 - 450 = 10 units, 451-500 = 12 units, >500 units = md/np. 4. mirtazapine 15 mg tablet : one (1) tablet po hs (at bedtime): 9 pm. 5. acetaminophen 325 mg tablet : two (2) tablet po four times a day as needed for pain: or temperature > 100. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q2hrs as needed for shortness of breath or wheezing. 7. bisacodyl 10 mg suppository : one (1) rectal once a day as needed for constipation. 8. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol: prn glycometer check < 70 special insrtuctions: if bs < 70 and resident unresponsive give glucagon 1 mg sub-q, recheck fs in 10 minutes, notify md/np. 9. milk of magnesia 400 mg/5 ml suspension : thirty (30) milli-liters po once a day as needed for constipation. 10. mylanta 200-200-20 mg/5 ml suspension : thirty (30) po four times a day as needed for heartburn. 11. morphine concentrate 100 mg/5 ml (20 mg/ml) solution : 0.25 milliliters po every twelve (12) hours as needed for pain. 12. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 13. miconazole nitrate 2 % powder : one (1) topical twice a day as needed for groin. 14. nystatin 100,000 unit/g powder : one (1) topical twice a day as needed for hand (right). 15. zinc oxide ointment : one (1) topical twice a day as needed for buttocks. 16. baclofen 10 mg tablet : 1.5 tablets po qid (4 times a day): g tube. 17. docusate sodium 50 mg/5 ml liquid : ten (10) po once a day as needed for constipation. 18. cymbalta 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po twice a day. 19. fentanyl 75 mcg/hr patch 72 hr : one (1) transdermal once a day: change q72 hours. 20. ferrous sulfate 220 mg (44 mg iron)/5 ml solution : five (5) ml po once a day. 21. gabapentin 250 mg/5 ml solution : one (1) po every eight (8) hours. 22. glucerna liquid : one (1) po qshift. 23. lansoprazole 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 24. insulin glargine 100 unit/ml solution : thirty four (34) subcutaneous at bedtime. 25. meropenem 500 mg recon soln : one (1) intravenous every eight (8) hours for 5 days: ending . 26. vancomycin 1,000 mg recon soln : one (1) intravenous every twelve (12) hours for 5 days: ending . discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: urosepsis v pneumonia discharge condition: mental status: nonverbal, nods to questioning level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: patient was admitted with hypotension concerning for septic shock. he was treated with meropenem and vancomycin and a picc line was placed for ongoing iv antibiotics. antibiotics should be continued through . patient will need vancomycin trough level checked tomorrow morning prior to 4th dose (). warfarin was held as inr supratherapeutic at 3.8. medication changes: start vancomycin 1000mg iv q12h ending start meropenem 500mg iv q8h ending hold warfarin until inr therapeutic followup instructions: department: care unit when: wednesday at 8:30 am building: de building ( complex) campus: west best parking: garage department: when: wednesday at 10:00 am building: cc clinical center campus: west best parking: garage procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: acidosis anemia, unspecified esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified other and unspecified hyperlipidemia septic shock long-term (current) use of anticoagulants pressure ulcer, lower back late effects of cerebrovascular disease, other speech and language deficits hyperosmolality and/or hypernatremia tracheostomy status pressure ulcer, stage ii 

Answer: The patient is high likely exposed to