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: pneumococcal vaccine / influenza virus vaccine / sulfa (sulfonamides) / penicillins attending: chief complaint: brbpr and coffee ground emesis major surgical or invasive procedure: lij was placed transfusion of 5 units of prbcs history of present illness: yo f with a history of cad, cva, gerd, mrsa uti, dm, and dementia (verbal but confused at baseline) presents to ed from from heb reb, with hypotension. she had one episode of emesis (non bloody ). she then reportedly complained of abd pain on the day of admission (), then had 1 episode of coffee ground emesis, followed by brbpr with clots. her bp at the was 60/p. . on arrival to the ed her blood pressure was 80/palp. was 26 (was 33 on ), lactate was 5.5, ua was grossly positive. fast was negative. abd ct revealed 2 cm clot vs mass in duodenum. gi and surgery were consulted. she was fluid resucutated, and initially her bp improved to 100 systolic, but then trended down to 70's. . potassium was initially 7.6, she was given calcium cl 1 g, insulin 5u. code sepsis was called, a l ij was placed (following a failed attempt at a r ij). she was given 3.2l ivf, vanco/levo/flagyl and transfused 2 units prbcs. on transfer to the micu she was afebrile hr 110, bp 90-100/40, satting 97% 2l nc. . ros: unable to obtain . past medical history: cad s/p angioplasty h/o cva dm2 with peripheral neuropathy (hgba1c = 6.6) ckd (b/l cr 1.8) diverticulitis s/p partial colectomy chronic hypotension (b/l bp = 90) hyperlipidemia dementia (oriented x 1 at baseline) h/o chronic anemia h/o mrsa uti recent cdiff (last dose ) possible chronic renal failure gerd sle h/o gallstone pancreatitis copd oa h/o cystitis low back pain h/o r knee surgery s/p sympathectomy social history: from rehab, former smoker- ppd x 80 years. no etoh. uses a walker. son is hcp. requires assistance for adl's, family history: nc physical exam: vs - temp 97.3 f, bp 112/80, hr 102, r 18, o2-sat 96% ra gen: sleepy but arousable--lapses back into sleep easily, oriented x1 to self only. follows simple commands, frail elderly woman, confused, moaning, very hard of hearing heent: , , eomi, anicteric , dry mm , op clear neck: supple, no jvd, no bruits, no lad heart: rrr, s1, s2, 2/6 sem at base, no ectopy lungs: crackles at b/l bases; no rh/wh, no accessory muscle use abd: generally tender/no rebound/no guard. no mass; no organomegaly; obese; bruisig of skin at site of medication injection. ext: no cce/erythema (blanching) rt foot; dp/pt dopplerable skin: stage i-ii sacral decub neuro: aa&ox1(to name), 5/5 strength arms; 4/4 strength both legs; cn2-12 grossly normal except for left hearing loss; babinski downgoing bilat. reflexes hard to elicit. pertinent results: ekg: sinus tach at 108, 1st degree av block, nonspecific stt changes . : baseline artifact. sinus rhythm. leftward axis. since the previous tracing the axis is more leftward. . ct pelvis w/o contrast : 4 cm hyperdense collection in the duodenum is concerning upper gi bleed(likely bleeding duodenual ulcer, but cannot rule out underlying mass). no intraperitoneal free fluid, free air or obstruction. . . 02:32pm glucose-251* urea n-47* creat-1.7* sodium-137 potassium-5.5* chloride-111* total co2-21* anion gap-11 02:32pm calcium-6.5* phosphate-4.4 magnesium-1.4* 02:32pm wbc-14.9* rbc-3.10* hgb-9.4* -27.2* mcv-88 mch-30.3 mchc-34.5# rdw-15.5 02:32pm plt count-222 01:07pm lactate-1.5 11:27am lactate-2.6* 09:45am lactate-2.9* 09:30am urine color-yellow appear-cloudy sp -1.015 09:30am urine blood-lg nitrite-pos protein-30 glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-mod 09:30am urine rbc-* wbc->50 bacteria-many yeast-none epi- 08:10am glucose-267* urea n-46* creat-2.0* sodium-138 potassium-5.6* chloride-108 total co2-25 anion gap-11 08:10am estgfr-using this 08:10am alt(sgpt)-9 ast(sgot)-12 ck(cpk)-17* alk phos-43 tot bili-0.3 08:10am lipase-16 08:10am ck-mb-notdone 08:10am albumin-1.9* calcium-6.0* phosphate-4.7* magnesium-1.5* 08:10am cortisol-27.3* 08:10am cortisol-27.3* 08:10am crp-3.4 07:19am lactate-5.5* k+-7.6* 07:15am ctropnt-0.03* 07:15am wbc-12.7* rbc-2.93* hgb-8.1* -26.1* mcv-89 mch-27.8 mchc-31.2 rdw-16.8* 07:15am neuts-81.2* lymphs-14.8* monos-3.1 eos-0.1 basos-0.8 07:15am plt count-440 07:15am pt-12.9 ptt-25.7 inr(pt)-1.1 . complete blood count wbc rbc hgb mcv mch mchc rdw plt ct 10:50am 34.9* 05:55am 7.9 3.82* 11.4* 33.7* 88 29.8 33.8 16.5* 138* 04:06am 8.5 4.02* 11.7* 36.4 90 29.1 32.2 16.3* 155 03:40pm 8.4 3.96* 12.1 36.1 91 30.5 33.5 16.2* 154 source: line-central 06:10am 8.3 4.11* 12.2 36.1 88 29.6 33.7 16.4* 188 12:18am 35.3* source: line-cvl 03:22pm 35.7* source: line-central 05:56am 12.3* 3.62* 11.0* 31.6* 87 30.2 34.7 16.2* 203 source: line-cvl 11:23pm 32.8* 07:28pm 33.9* source: line-central 04:36pm 17.1* 4.10* 11.9* 35.7* 87 29.1 33.4 16.0* 190 source: line-cvl 02:23pm 33.3* source: line-left ij 09:28am 35.1* source: line- left ij 05:56am 15.4* 4.17*# 12.3# 35.7* 86 29.5 34.4 15.8* 196 . . renal & glucose glucose urean creat na k cl hco3 angap 05:55am 101 28* 1.3* 141 4.81 110* 19* 17 06:10am 113* 39* 1.4* 142 4.6 112* 22 13 05:56am 157* 51* 1.5* 141 4.7 112* 20* 14 source: line-cvl 04:36pm 196* 57* 1.6* 138 5.3* 109* 20* 14 source: line-cvl 02:23pm 152* 58* 1.5* 137 5.7* 111* 21* 11 source: line-left ij 09:28am 5.7* source: line- left ij 05:56am 177* 62* 1.6* 136 5.8* 109* 21* 12 source: line-central 02:32pm 251* 47* 1.7* 137 5.5* 111* 21* 11 source: line-tlc 08:10am 267* 46* 2.0* 138 5.6* 108 25 11 . . . cortisol 08:10am 27.3*1 . lactate: 01:07pm 1.5 11:27am 2.6* 09:45am 2.9* 07:19am 5.5* . alt ast ck alkphos totbili 9 12 17 43 0.3 . final on discharge 34.9 . catheter tip-iv wound culture-preliminary inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-final {escherichia coli, escherichia coli} emergency blood culture blood culture, routine-pending emergency blood culture blood culture, routine-preliminary {lactobacillus species}; aerobic bottle gram stain-final emergency . urine culture (final ): escherichia coli. >100,000 organisms/ml.. escherichia coli. >100,000 organisms/ml.. 2nd morphology. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | ampicillin------------ 16 i <=2 s ampicillin/sulbactam-- 8 s <=2 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 16 i 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- <=16 s <=16 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s brief hospital course: f presents with history of gerd, dementia, mrsa uti admitted to micu from with shock, uti and gi bleed. . # sepsis/uti/bacteremia - initially hypotensive in ed, baseline per her pcp 36, down to 26 on admission, thus hypotension felt most likely hypovolemic from gi bleed, but may have had septic component as well given +ua on , +leukocytosis (wbc 17.1). cvp = 4. given 3.2 l ivf, 2 units prbc's in ed. never required pressors in the icu. she recieved ~4l ivf in the micu, and 4u prbcs. she was treated with broad spectrum abx vanc/cipro/flagyl for 1d in the icu. she was transferred to the floor on . vanco and flagyl were discontinued given the presence of gram negative rods on urine culture, and no other source of infection. her urine speciated e.coli resistant to quinolones, and she was switched to oral bactrim based on sensitivities. she has a history of reported bactrim allergy. after discussion with her pcp, was determined that she has taken bactrim in the past in without adverse reaction. she tolerated bactrim without difficulty. . blood cultures on were positive for lactobacillus in 1 of 2 bottles. subsequent cultures on , showed no growth at the time of discharge. left ij catheter tip was cultured and showed no growth at the time of discharge. id consult was obtained, and recommended clindamycin iv x 14 days to treat potential lactbacillus bacteremia starting on . a picc line was placed for this antibiotic. she was also started on a 21 day course of oral vancomycin (starting ) for c. difficile prophylaxis given her recent c. difficille infection. she was hemodynamically stable upon transfer to the medical floor and had no further hypotension. . she should have follow-up of her bacteremia with either her primary care physician or the gerontology service at rehab. she does not require surveillence cultures. . # gib bleed - most likely due to duodenal ulcer given ct scan. gi and surgery were consulted, and given the patient and son's desire for conservative management, it was agreed upon that no intervention would be performed unless pt developed life threatening bleed. pt received total of 5u prbcs last on . her was stable at 33-35 on discharge on . she was tolerating a regular pureed diet with supervision given concern for aspiration while recovering from uti. she was discharged home on omeprazole twice daily. her aspirin and plavix were discontinued. she should discuss restarting her aspirin with her primary care physician in the future. . . # hyperkalemia - k up to 5.8 on , down to 4.8 on without intervention. no ekg changes. some question of rta as source of chronic hyperkalemia. potassium resolved without intervention. she will follow-up with her pcp. . . # recent c diff - pt finished po vancomycin . she had melanotic stools this admission, though no diarrhea. she was started on po vanco on for 21 day course to prophylax against cdiff given that she is starting a new course of bactrim for uti and clindamycin for bacteremia. . . # ckd: baseline cr 1.8 per report, down to 1.3 on . medications were renally dosed. no evidence of atn. . # dm - pt was covered with sliding scale insulin while inpatient. . # gout - pt continued home regimen of allopurinol. . # anemia - baseline hgb is approximately 12 per discussion with patients' pcp. down to 26 on admission consistent with gib. at time of discharge 34.9. iron supplementation was held in setting of gib, and can be restarted as outpatient. . # cad - given ongoing gib as above, decision made to hold aspirin and plavix. no clear indication for continue plavix given lack of recent nstem, cva, or pad. pt will need to discuss restarting aspirin with pcp once hematocrit has been stable. . # copd - pt continued on her home regimen of fluticasone and spiriva. she was breathing comfortably on room air at the time of discharge. . # access - l ij placed in setting of hypotension in icu. this was discontinued on , and tip was cultured. picc was placed for iv antibiotics which will continue for 14 days, afterwhich time picc can be discontinued. . # fen - pt advanced to regular pureed diet on . pt kept on aspiration precautions given that she remains drowsy in setting of her uti. . # code: pt's code status was made dnr/dni per discussion with son, hcp in keeping with patient's wishes. son is hcp. . # dispo: pt being discharged to rehab. plan is to complete antibiotics as above (bactrim for uti, clindamycin for lactobacillus bacteremia), and oral vancomycin for cdiff prophylaxis. she will readdress aspirin use as above. medications on admission: tylenol spiriva aspirin 81 mg feso4 daily plavix 75 mg fluticasone 220 mcg 1 puff milk of mag trazodone 50 hs prn allopurinol 100 mg daily hiss prilosec tums vit d 1000u dialy maalox prn lactobacillus discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 3. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 6. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 8 days: allegy noted. pcp said that he has never documented a reaction to it. 7. insulin lispro 100 unit/ml solution sig: one (1) units subcutaneous asdir (as directed). 8. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 9. maalox 200-200-20 mg/5 ml suspension sig: one (1) po every 4-6 hours as needed for heartburn. 10. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 11. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 21 days: last day . 12. clindamycin phosphate 150 mg/ml solution sig: one (1) 600mg injection q8h (every 8 hours) for 14 days: 600 mg iv q8hr, last day . discharge disposition: extended care facility: center discharge diagnosis: primary diagnosis: upper gi bleed urinary tract infection bacteremia . secondary diagnosis: coronary artery disease dementia discharge condition: you are being discharged at your baseline level of functioning. your vital signs are stable and you have been assessed by physical therapy. discharge instructions: you were admitted after an ulcer in your gi tract bled enough that your vital signs become unstable and you required admission to the intensive care unit. after blood transfusions and careful monitoring, your vital signs stabilized and you were followed on the regular floors. you were also treated with antibiotics for a urinary tract infection and an infection in your blood stream. . the following changes were made to your medications" 1)you will need to take bactrim for your urinary tract infetion. please take 1 tablet by mouth twice a day for the next 8 days to end on . 2)we have discontinued your plavix, the milk of magnesia, tums, and lactobacillus. 3)please discuss with your rehab doctors when to your aspirin. 4)the prilosec should now be taken twice a day by mouth. 5)please take clindamycin 600mg iv every 8 hours for 5 days to end . this is the treat the bacteria in your blood. 6)please take vancomycin 250mg by mouth 4 times a day for 12 days to end on . this is to prevent you from getting diarrhea from your other antibiotics. . you will be followed by the doctors rehab. . if you develop any of the following: chest pain, shortness of breath, palpataion, dizziness, nausea or vomiting, or bloody stools, please notify the doctors at rehab go to your local emergency room. followup instructions: the doctors at rehab take care of you and will make recommendations that your should follow. procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified acute kidney failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified other and unspecified hyperlipidemia septic shock pressure ulcer, lower back chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to