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: penicillins / simvastatin attending: chief complaint: abdominal and suprapubic pain major surgical or invasive procedure: none history of present illness: 79 year old male, cantonese-only speaking man with hypertension, hyperlipidemia, cad s/p cabg () with perc chole tube for cholecystitis/duodenitis and sepsis in , recently discharged from on s/p chole and cholangitis treated with antibiotics -- now presenting with complaints of lower abdominal pain. the patient reports feeling well until 2-3 days ago, when he started having lower abdominal and suprapubic pain. rates the pain as a in the suprapubic area. he also believes he is retaining urine. associated symptoms include chills, + urgency and dysuria. he also endorses hematuria with small clots in his foley bag -- but no stream of blood in the urine. he had a foley placed during his last hospitalization and he was suppose to see urology as an outpatient for possible removal of foley today. he was also completing a course of antibiotics from his last hospitalization -- his last dose of clindamycin was today. also reports loose stools. the patient denies fever, nausea, vomitting, sob or cough. in the ed, initial vitals were 100.1 114 124/56 18 98%. abdominal exam showed suprapubic tenderness, but no cva tenderness. labs showed wbc count of 21.8k with 96% neutrophils. lactate was 1.5. lfts showed alkaline phosphatase of 207, alt of 42. chest x-ray showed a left lower lobe consolidation. urinalysis showed >182 wbcs, >182 rbcs, large leukocytes, moderate blood, 10 ketones, and 30 protein. patient was started on vancomycin 1 gram iv x 1, ciprofloxacin 400 mg iv x 1. vitals upon transfer were 95 105/51 16 96%. on the floor, vs were: t 100.3 p 100 bp 119/54 r 20 o2 sat 99ra. the patient endorsed ongoing abdominal pain. he rated the pain as a , worse with movement. he expressed interest in having the foley catheter removed and trying to void on his own. he denied shortness of breath, difficulty breathing, wheezing, cough, or fevers. reported intermittent sweating and chills. past medical history: - coronary artery disease s/p cabg (lima to the lad and - separate svgs to the pda and an om) - hld - htn - bph - emphysema per ct scan - tuberculosis many years ago, treated for 2 years - s/p cholecytectomy and cholangitis social history: prior 20 pack year smoker, quit 20 years ago. retired ceo of auto parts business in . lives with his wife and is independent with adls. rare alcohol, denies illicits. family history: mother had hypertension and history of cancer. physical exam: physical exam at admission: vitals: t: 100.3 bp: 119/54 p: 100 r:20 o2:99%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, multiple brown macules on forhead and scalp neck: supple, jvp not elevated lungs: clear to auscultation bilaterally with the exception of decreased breath sound in left lower quadrant, no wheezes, rales, ronchi, no egophony cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, bowel sounds present, no rebound tenderness or guarding, no organomegaly, + tenderness to moderate palpation in suprapubic area and bilateral lower abdominal quadrants, +distended bladder ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema physical exam at discharge: vitals: tm 99.1 tc 97.8 112/60 67 20 94-98%ra i/o: 8hr: 24hr: 2600/3550+bmx1 general: alert, oriented, no acute distress heent: nc/at, sclera anicteric, mmm, neck: supple, jvp not elevated, no lad cv: rrr, ii/vi sem at lusb, nl s1 s2 lungs: bilateral crackles way up, good air movement abdomen: s, nt/nd, bs+, no suprapubic tenderness gu: no foley ext: wwp no c/c/e neuro: alert, oriented, appropriate, non-focal pertinent results: labs at admission: 09:03am blood wbc-21.8*# rbc-4.22* hgb-12.9* hct-37.6* mcv-89 mch-30.5 mchc-34.2 rdw-14.9 plt ct-381# 09:03am blood neuts-92.6* lymphs-2.9* monos-4.0 eos-0.3 baso-0.1 09:03am blood glucose-103* urean-13 creat-1.0 na-136 k-3.5 cl-99 hco3-25 angap-16 09:03am blood alt-42* ast-28 alkphos-207* totbili-1.2 09:03am blood alt-42* ast-28 alkphos-207* totbili-1.2 09:23am blood lactate-1.6 discharge labs 07:05am blood wbc-4.4 rbc-3.61* hgb-11.0* hct-32.4* mcv-90 mch-30.5 mchc-34.0 rdw-14.8 plt ct-305 07:05am blood glucose-98 urean-8 creat-0.6 na-139 k-3.9 cl-103 hco3-27 angap-13 07:05am blood calcium-8.6 phos-3.6 mg-1.9 imaging: cxr : impression: left lower lobe opacity concerning for pneumonia. liver/gallblader u/s (preliminary report) : impression: 1. patient is status post cholecystectomy. no fluid collections identified. no intrahepatic or extrahepatic biliary duct dilatation. 2. heterogeneous echogenic liver consistent with fatty infiltration however other forms of more severe liver disease are not excluded. renal ultrasound impression: simple renal cyst as on previous studies without evidence of renal abscess. microbiology: urine culture 8:16 am urine **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- =>64 r cefepime-------------- 2 s ceftazidime----------- 4 s ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 256 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r urine culture urine culture (final ): gram negative rod(s). ~5000/ml. blood culture - ngtd - ngtd cdiff - negative blood culture : blood culture, routine (preliminary): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- =>64 r cefepime-------------- 2 s ceftazidime----------- 4 s ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r anaerobic bottle gram stain (final ): reported to and read back by dr. , shinwa @ 1010pm . gram negative rod(s). bld culture , , ngtd urine studies: 06:53am urine color-straw appear-clear sp -1.004 06:53am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-mod 06:53am urine rbc-5* wbc-5 bacteri-few yeast-none epi-0 08:16am urine color-yellow appear-hazy sp -1.015 08:16am urine blood-mod nitrite-pos protein-30 glucose-neg ketone-10 bilirub-neg urobiln-neg ph-6.5 leuks-lg 08:16am urine rbc->182* wbc->182* bacteri-many yeast-none epi-0 brief hospital course: 79 year old male with significant pmh for hypertension, hyperlipidemia, cad s/p cabg () with perc chole tube for cholecystitis/duodenitis and sepsis in , recently discharged from on s/p chole admitted with abdominal pain and found to have uti and became septic with transfer to the icu which stablized with iv hydration and found to have ecoli bacteremia who was stablized and requiring iv cefepime at the time of discharge. active issues: # pneumonia: at admission in the ed the patient presented with signs of infection including leukocytosis, low and grade temperature. cxr in ed was suggestive of left lower lobe consolidation. in the ed he was empirically treated with vancomycin, cefepime and cipro. given that he was recently hospitalized and discharge he was treated for hcap with vanc/cefepime. he will complete a 7 day hcap treatment course on (at which time he will stop his vancomycin). while in the icu he had a new oxygen requirement, hwoever this weaned off with iv abx and autodiuresis. he had no oxygen requirement at the time of discharge, and his lungs were clear. # uti: at presentation in the ed the patient reported lower abdominal pain, urgency and dysuria. his urine in the ed was remarkable for nitrites, +180 rbcs and +180 wbcs. he was given vancomycin, cefepime and cipro in the ed. his greatest risk for developing uti was that he had a foley placed during his last hospitalization. urine grew e. coli with multiple resistance but was sensitive to cefepime. blood cultures came back positive for ecoli that was also sensitive to cefepime and therefore likely urosepticiemia. #urinary retention- patient was admitted with indwelling foley from his recent sugery leading to urinary retention. this was removed during his hospitalization and he was voiding without difficulty at the time of discharge. -doxazosin was discontinued as he dropped his blood pressure while on this and was no longer having urinary retention at the time of discharge. #ecoli bacteremia-patient had blood cultures that grew ecoli with similar sensitivities to -will need to finish cefepime on for a 7 day course from day 1 of negative cultures on -blood cutlures from , 15, and 16 were ngtd at the time of discharge and final cultures will be monitored by his inpatient team and communicated with his pcp if they become positive # h/o cholangitis s/p chole: at admission the patient reported abdominal pain. patient with recent cholecystitis requiring perc chole tube in . did not have a cholecystectomy at that time due to inflammation but is now s/p choleocystectomy after having surgery earlier this month. in the ed he had ruq u/s which was notable for no ongoing evidence of infection or fluid connection. in the ed his abdominal pain was treated with oxycodone. he was evaluted by surgery in the ed who found no acute surgical issues. serial abdominal exams were unremarkable. chronic issues: # cad s/p cabg: cagb with lima to lad and separate svgs to pda in . denied symptoms of chest pain, chest pressure or fatigue at admission. he was dontinued home medications including his asa and statin. his antihypertensives (metoprolol and lisiopril) were held at admission as he was hypotensive to normotensive in the ed. his metoprolol was restarted on and switched from succinate to tartrate (12.5mg ). his lisinopril was still held and will need to be restarted for cardioprotective effects once it is clear that he is tolerating his metoprolol -restart lisinopril 2.5 mg po qday if tolerating betablocker -consider switching metop tartrate back to succinate when discharged back home for convenience -continued aspirin and atorvastatin # emphysema: stable. h/o possible obstructive ventalitory defect on pfts from and ct scan with evidence of emphysema. he was continued on tiotropium during this admission. # hypertension: see above changes made -stopped doxazosin -switched -held lisinopril # hyperlipidemia: stable. continued on home atorvastatin. # gerd: stable. continued on home omeprazole. # restless leg: stable. continued on home ropinirole. transitional issues: -continue cefepime iv through -continue vancomycin iv through -restart lisinopril 2.5mg po qday once blood pressure stable on metoprolol -labs pending at the time of discharge (blood cultures from , , )- will be followed-up by inpatient team -> final results showed no growth medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver. 1. aspirin 81 mg po daily 2. atorvastatin 10 mg po daily 3. doxazosin 4 mg po hs 4. omeprazole 40 mg po daily please take 30 minutes prior to meal 5. ropinirole 1 mg po tid 6. acetaminophen 650 mg po q6h:prn pain please do not exceed 2g/24hrs 7. docusate sodium 100 mg po bid 8. oxycodone (immediate release) 2.5-5.0 mg po q4h:prn pain please monitor and hold for sedation, rr<12 or ams 9. senna 1 tab po bid:prn constipation 10. tiotropium bromide 1 cap ih daily 11. metoprolol succinate xl 25 mg po daily 12. lisinopril 2.5 mg po daily discharge medications: 1. acetaminophen 650 mg po q6h:prn pain please do not exceed 2g/24hrs 2. aspirin 81 mg po daily 3. atorvastatin 10 mg po daily 4. docusate sodium 100 mg po bid 5. omeprazole 40 mg po daily please take 30 minutes prior to meal 6. ropinirole 1 mg po tid 7. senna 1 tab po bid:prn constipation 8. tiotropium bromide 1 cap ih daily 9. vancomycin 1500 mg iv q 12h to end on 10. cefepime 1 g iv q12h to end on 11. metoprolol tartrate 12.5 mg po bid 12. phenazopyridine 100 mg po tid duration: 3 days discharge disposition: extended care facility: livingcenter - discharge diagnosis: ecoli bacteremia urinary tract infection and urosepsis hospital-associated pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at the ! you were admitted to the hospital because of abdominal pain. here, we found that you had a urinary tract infection and a pneumonia. the bacteria from the urine was also found in your blood. we are treating you with iv antibiotics which you will need to continue through and you will receive these at rehab. please keep all follow up appointments. please take all medications as prescribed. followup instructions: provider: care clinic phone: date/time: 3:00 provider: , md phone: date/time: 11:00 procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified esophageal reflux urinary tract infection, site not specified unspecified essential hypertension unspecified septicemia hyposmolality and/or hyponatremia severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) septic shock other emphysema gross hematuria other specified retention of urine restless legs syndrome (rls) 

Answer: The patient is high likely exposed to