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: codeine / oxycodone attending: chief complaint: osh transfer for ercp major surgical or invasive procedure: ercp with stent history of present illness: yo f with history of cad, subdural hematoma who presented to on with epigastric abdominal pain, vomiting, and abnormal lfts. she is known to be s/p cholecystectomy over 30 years ago. she initially received ct abd and pelvis with contrast () which showed pneumobilia consistent with post-cholecytectomy changes. received an mrcp on at , which showed dilated intra and extrahepatic bile ducts as well as multiple filling defects suspicious for stones and debris. she was noted on medical floor to spike a fever to 104 and subsequently had sbp in the 70s and hr up to the 140s. she was started on piperacillin/tazobactam. patient was given a small iv fluid bolus (~250 ml) and transferred to the icu. central access was obtained with a triple lumen catheter (unintentionally placed in the patient's femoral artery), norepinephrine drip was started, and patient was transferred to for ercp and ongoing icu care of sepsis. in the icu, the patient reports feeling fine. she is denying any abdominal pain at rest, current nausea, or vomiting. she also denies fever or chills. notes that she has not had a bowel movement in the last day, so she is unsure about having diarrhea or constipation. she denies any chest pain or difficulty breathing. review of systems: *somewhat limited by patient's somnolence* (+)ve: fever, nausea, vomiting, episgastric abdominal pain (-)ve: chills, night sweats, loss of appetite, fatigue, chest pain, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, + diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: 1) cad with stents in place - on plavix 2) diabetes mellitus 3) hypertension 4) vertigo wih falls 5) subdural hematoma seconary to fall in - evacuated 6) anxiety 7) osteoarthritis 8) s/p cholecystectomy 9) s/p left hip replacement social history: patient lives alone. ambulates with a walker. tobacco: denies etoh: denies illicits: denies family history: non-contributory physical exam: vs: t 95.4, hr 72, bp 112/55, rr 15, o2sat 97% 2l nc gen: elderly patient appearing younger than stated age, though looking comfortable heent: perrl, eomi, oral mucosa slightly dry neck: supple, no jvp elevation pulm: ctab anteriorly card: rr, nl s1, nl s2, iii/vi sem heard best at rusb abd: bs+, soft, tender diffusely which was evidenced by grimacing ext: triple lumen catheter in patient's right groin, patient's right lower extremity is cooler than left neuro: oriented x 3, cn ii-xii intact psych: affect flat pertinent results: on : wbc 14.3 alt 255, ast 221, bili 3.2, aphos 200 ck 85, trop 0.15 . on : wbc 9.4, hct 35.4 na 129, k 3.9, cl 94, co2 24, bun 18, cr 0.74 alt 252, ast 265, bili 2.5, aphos 199, inr 0.99 ck 92, trop 0.03 . studies: mrcp : impression: "dilated intra and extrahepatic bile ducts. the common bile duct measures about a centimeter in diameter and contains multiple filling defects of mixed signal intensity suspicious for common duct stones and debris. there may also be stones in the right hepatic duct though this area is limited due to metallic surgical clips." ct abdomen and pelvis : impression: "pneumobilia with assoicated postoperative change in the gallbladder fossa and dilated extrahepatic ducts. this may be a chronic finding reflecting prior instrumention." . : ecg: normal sinus rhythm, rate 94. leftward axis at minus 5 degrees. early transition. slight diffuse non-specific st-t wave changes. no previous tracing available for comparison. these slight st-t wave changes are non-specific and non-diagnostic. . : cxr: the right internal jugular line tip is at the proximal right atrium and might be pulled back for approximately 3 cm to secure its position at the low svc. the heart size is top normal. mediastinal position, contour and width are unremarkable. lungs are essentially clear except for potentially present left retrocardiac opacity that might represent area of atelectasis. no appreciable pleural effusion is demonstrated and there is no pneumothorax. . : cxr: status post placement of a left-sided picc terminating within the mid svc. . tte: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . . ercp: findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: the anatomy was unusual at the major papilla. either the patient has had previous biliary intervention that she does not recall, or a biliary-enteric fistula is present. cannulation: cannulation of the biliary duct was successful and deep with a 5-4-3 tapered catheter using a free-hand technique. contrast medium was injected resulting in partial opacification (biliary tree only partially opacified due to the presence of cholangitis) biliary tree: multiple biliary stones that were causing partial obstruction were seen at the biliary tree. sludge and pus was released from the bile duct during cannulation. a 7cm by 10fr cotton biliary stent was placed successfully. impression: * the anatomy was unusual at the major papilla - either the patient has had previous biliary intervention that she does not recall, or a biliary-enteric fistula is present * cannulation of the biliary duct was successful and deep with a 5-4-3 tapered catheter using a free-hand technique. * contrast medium was injected resulting in partial opacification (biliary tree only partially opacified due to the presence of cholangitis) * multiple biliary stones that were causing partial obstruction were seen at the biliary tree. * sludge and pus were released from the bile duct during cannulation. * a 7cm by 10fr cotton biliary stent was placed successfully * otherwise normal ercp to third part of the duodenum recommendations: depending on clinical status, patient can have clear fluids today continue supportive icu care as needed ercp in one month when off plavix for 7 days for stone extraction should remain on antibiotics for a total of 7 days . . 11:44pm blood wbc-12.1* rbc-3.27* hgb-9.9* hct-29.9* mcv-91 mch-30.2 mchc-33.0 rdw-13.4 plt ct-112* 02:15pm blood wbc-9.9 rbc-3.14* hgb-9.6* hct-28.0* mcv-89 mch-30.7 mchc-34.3 rdw-13.2 plt ct-128* 03:44am blood wbc-6.1 rbc-2.82* hgb-8.5* hct-25.6* mcv-91 mch-30.1 mchc-33.1 rdw-13.2 plt ct-128* 05:46am blood wbc-7.2 rbc-3.20* hgb-9.6* hct-29.2* mcv-91 mch-30.1 mchc-32.9 rdw-13.1 plt ct-229 11:44pm blood neuts-90.1* lymphs-6.3* monos-3.4 eos-0 baso-0.1 05:19am blood neuts-86.4* lymphs-9.3* monos-4.1 eos-0.2 baso-0 05:46am blood plt ct-229 11:44pm blood pt-14.6* ptt-29.1 inr(pt)-1.3* 05:19am blood pt-14.7* ptt-28.8 inr(pt)-1.3* 03:05am blood pt-12.6 ptt-25.5 inr(pt)-1.1 11:44pm blood glucose-180* urean-21* creat-1.0 na-136 k-3.7 cl-102 hco3-22 angap-16 03:05am blood glucose-82 urean-22* creat-0.7 na-142 k-3.5 cl-110* hco3-20* angap-16 06:00am blood glucose-195* urean-8 creat-0.4 na-137 k-3.6 cl-100 hco3-29 angap-12 05:46am blood glucose-155* urean-7 creat-0.4 na-141 k-3.7 cl-101 hco3-33* angap-11 11:44pm blood alt-167* ast-83* ld(ldh)-190 ck(cpk)-104 alkphos-172* totbili-4.4* 03:05am blood alt-94* ast-34 alkphos-140* totbili-2.2* 06:00am blood alt-56* ast-23 alkphos-189* totbili-1.7* 05:46am blood alt-52* ast-27 alkphos-208* totbili-1.2 11:44pm blood ck-mb-3 ctropnt-0.03* 05:19am blood ck-mb-4 ctropnt-0.03* 11:44pm blood albumin-3.1* calcium-7.6* phos-3.3 mg-2.1 05:46am blood calcium-8.3* phos-2.1* mg-1.5* 03:44am blood caltibc-225* ferritn-87 trf-173* 04:16am urine color-yellow appear-hazy sp -1.016 04:16am urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirub-mod urobiln-neg ph-5.5 leuks-mod 04:16am urine rbc-5* wbc-66* bacteri-none yeast-none epi-3 04:16am urine castgr-1* 04:16am urine mucous-rare . . micro: 9:47 pm stool consistency: watery source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . . 4:18 am blood culture site: a line source: line-art rt fem. **final report ** blood culture, routine (final ): no growth. . . 4:16 am urine source: catheter. **final report ** urine culture (final ): no growth. . . 2:08 am blood culture **final report ** blood culture, routine (final ): no growth. brief hospital course: year old female with history of cad and subdural hematoma who presented to on with epigastric abdominal pain, vomiting, and abnormal lfts. #. cholangitis and gnr bacteremia (from ): she presented with symptoms (fevers, bandemia, and abdominal pain) consistent with cholangitis and sepsis, and osh cultures grew gram negative rods. she was maintained on zosyn which had been started at . vancomycin was for additional empiric coverage for presumed cholangitis and sepsis of unclear etiology but was stopped on after clinical improvement and no further growth in cultures. ercp was performed on which revealed pustular exudates, stones and sludge. a common bile duct stent was placed. lfts were initially elevated and trended down. picc was placed on for planned 2 weeks of antibiotics (zosyn). . upon arrival to the medical floor, her sensitivities confirmed quinolone sensitive klebsiella bacteremia. she was therefore switched to oral ciprofloxacin to complete a total of 14 days. her picc line was discontinued. blood cultures from showed ngtd at time of discharge. . she will need to have repeat ercp in weeks (provided pt information to call to schedule), with plavix discontinuation 7d prior to procedure. discussed this plan with pcp on the day of discharge, who is aware, and will see pt in weeks (pt instructed to call pcp to schedule appt). . #. hypotension: ms. was hypotensive to sbps 70-80 at the osh. she arrived with pressors running through a femoral arterial line. cvl in right ij was placed on . she was started on levophed in the icu which was stopped at 230am on . she was also given gentle ivf boluses as she continued to have good uop, good mentation and good peripheral warmth. . upon arrival to the medical floor, her hypotension had resolved. . # hypoxia - pt with 2l o2 requirement upon arrival to the medical floor. this was felt likely ards physiology in setting of sepsis, and was weaned off on the night of her arrival to the medical floor. . #. coronary artery disease: troponins were increased at osh but were unchanged here. her plavix was continued and home medications of isosorbide mononitrate, lisinopril, atenolol were held given hypotension. her troponin leak was felt most likely demand. . #. femoral arterial line: was meant to be a central line placed at osh. it was discontinued on without complication. she reported no pain and there was no bruit or hematoma. initially the right foot was cooler vs left but this resolved after line was removed. upon arrival to the medical floor, her distal pulses remained 2+ bilaterally at dp/pt. #. thrombocytopenia: she had stable thrombocytopenia (128) during this admission. #. diabetes: glipizide was held and hiss was used. #. goals of care: she expressed a desire to be dnr, no cpr, though would allow short term intubation for a short period of time for procedures such as ercp. #. communication: with patient and son, : medications on admission: home medications: 1) ezetimibe 10 mg po daily 2) paroxetine 20 mg po daily 3) isosorbide mononitrate 60 mg po daily 4) atenolol 25 mg po daily 5) plavix 75 mg daily 6) glipizide 5 mg po daily 7) lisinopril 5 mg po daily 8) xanax prn anxiety transfer medications: 1) protonix 40 mg iv q24h 2) motrin 600 mg po q6h:prn pain or fever 3) morphine prn 4) isosorbide mononitrate 60 mg po daily 5) xanax prn anxiety 6) lisinopril 5 mg po qam 7) plavix 75 mg po daily 8) zosyn 3.375 g q8h 9) levophed titrated to keep systolics > 90 10) ns ivf @ 200 ml/hr allergies: codeine / oxycodone discharge medications: 1. ezetimibe 10 mg tablet sig: one (1) tablet po once a day. 2. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 3. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 4. atenolol 25 mg tablet sig: one (1) tablet po once a day. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. glipizide 5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 8. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 12 days. disp:*24 tablet(s)* refills:*0* 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gi upset. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. discharge disposition: home with service facility: partners discharge diagnosis: primary: acute cholangitis klebsiella bacteremia discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted to the hospital with an infection of your bile ducts. this was treated with an ercp procedure at which time multiple stones, and pus were seen. a stent was placed to help facilitate drainage. . you will need a repeat ercp procedure in weeks to have the stent removed, and the stones treated. . the following changes were made to your medications: 1. you were placed on a 14 day course of ciprofloxacin. followup instructions: you will need to have a repeat ercp with dr. in 4 weeks to remove the stones seen during this admission. we were unable to schedule this appointment for you today. please call dr. office at ( to schedule this appointment within 4-6 weeks of your discharge. . please stop your plavix 7 days before the scheduled date of the above procedure. . upon arriving home please contact your primary care physician, , . , and arrange for an appointment within 2-3 weeks for routine follow-up. we have spoken with dr. to inform him of your course, and he should receive a faxed copy of your discharge summary within 24 horus of discharge (fax ). procedure: venous catheterization, not elsewhere classified endoscopic dilation of ampulla and biliary duct arterial catheterization endoscopic insertion of stent (tube) into bile duct diagnoses: thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis percutaneous transluminal coronary angioplasty status dysthymic disorder other shock without mention of trauma septic shock other acquired absence of organ osteoarthrosis, unspecified whether generalized or localized, site unspecified other septicemia due to gram-negative organisms hypoxemia cholangitis hip joint replacement calculus of bile duct without mention of cholecystitis, with obstruction history of fall benign essential hypertension 

Answer: The patient is high likely exposed to