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 / erythromycin base / demerol / ceftriaxone attending: chief complaint: altered mental status and hypertension major surgical or invasive procedure: none history of present illness: this is a 68 year old female with past medical history of multiple mdr infections/sepsis in multiple sources (vre, esbl, c. glabrata and parapsilosis in urine, blood, joints), metatstatic ovarian cancer with liver mets s/p xrt and chemo c/b radiation-induced enteritis and multiple admissions for sbos as well as chemotherapy-associated cardiomyopathy (ef of 50% in ), presents from her rehabilitation center with increased confusion and hypertensive urgency (bps 200s/100s). she suffers from chronic abdominal pain and was given dilaudid before becoming somnolent. she was given narcan 0.4 mg x 2 and lopressor 5mg x 1 at the rehab and slightly improved. the patient recently finished a course of linezolid at the rehab on for vre. . in the ed, her initial vs were p 68, bp 192/116, r 12, o2 100%. she was put on a nitro gtt briefly, with a rapid response of her bp to 127/74 with a hr of 74. ekg showed nsr, st dep v3-v5, i. she was given narcan 2 mg x 1 with minimal improvement in mental status. imaging - ct head was negative, kub showed dilated loops of bowel and sbo could not be excluded, but her abdominal pain improved as she woke up more. . the patient was initially admitted to the floor and quickly transferred to the micu for an acute worsening of her mental status and bp of 70/dopplerable. in the micu, the patient became progressively oliguric, but renal u/s was negative. her blood pressure responded well to fluids and she became hypertensive, prompting administration of labetalol and hydralazine for better control with return of urine output, but transient bradycardia. further work-up of her hypotension included a cxr showing multifocal opacities and ct scan with ? consolidation. her urine culture grew e.coli once again and she was started on linezolid and meropenem for suspected esbl organisms. she has not had any respiratory issues. her hct has been dropping (13 pts in total from admission), stool guaiac neg. ct abdomen did not show an rp bleed. she is s/p 1 unit yesterday and hct is at baseline in mid 20s and now stable. she has never been febrile and her mental status has remained stable. . upon transfer to the floor, vitals are 97.1, 159/76, 84, 19 and 100%ra. she continues to have diffuse abdominal pain and is experiencing increased rue swelling, so much so that she cannot wear her watch anymore. she reports watery diarrhea, worse over the last 4 days than her chronic diarrhea, as well as 4 days of burning/frequency on urination. she is alert and oriented, but tearful about her illnesses. she has lost 60 lbs over the last 2 years due to her chronic diarrhea. . review of systems: (+) per hpi (-) , chills, night sweats, recent gain. headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting. denied arthralgias or myalgias. . past medical history: *gi - multiple admissions (reportedly ~ 100) for partial sbo, usually managed conservatively, most recently - . *id - recent hip fracture mssa osteomyelitis on , on daptomycin for 6 weeks, recently discharged from rehabilitation in early - h/o mrsa bacteremia (), (), (), complicated by l2-l3 discitis/osteomyelitis, failed 4 month course of vancomycin, resolved with surgical intervention with l2, l3 partial corpectomy/debridement on followed by 3 month course of vancomycin - c. glabrata sepsis - c.diff colitis , neg c.diff toxin - c.parapsilosis line-associated bsi () - p.vulgaris pyelonephritis w/ bilat hydronephrosis dx , treated with meropenem --> ciprofloxacin . *heme/onc -ovarian cancer: dx in , stage iv metastatic to liver, s/p tah-bso, adriamycin and xrt -iron deficiency anemia -h/o rue brachial thrombus, picc associated, in -h/o lue dvt . *cv -chemotherapy-associated cardiomyopathy, last echo in with ef of 50% -s/p left mca cva (on warfarin) - -hyperlipidemia . *other -chronic kidney disease (baseline cr 1.3-1.5) -osteoporosis -hypothyroidism -depression -tonsillectomy, adenoidectomy -appendectomy social history: patient currently in a rehab. formerly lived with her husband, has 2 grown sons, and 3 grandchildren. she was a nurse until 6 months ago. she is a remote smoker. no etoh, recreational drug use. walks with a walker at baseline secondary to hip pain. family history: breast cancer in maternal grandmother. prostate cancer in maternal grandfather. physical exam: on transfer to medical floor (from icu) . vs: t 97.1, bp 159/76, hr 84, rr 19 and 100% on ra ga: aox3, nad heent: perrla, eomi, mild proptosis, mmm, oropharynx clear neck: no lad, minimal jvd, +thyromegaly (r lobe > l) cv: rrr, nl s1/s2, no m/r/g pulm: decreased air entry and rales at the bases b/l abd: +bs, soft, diffusely tender, no rebound/guarding extremities: hands/feet cool, with marked rue edema and no le edema, dps and radials 2+. skin: no rashes/lesions neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. sensation intact to lt in all 4 extremities. cerebellar fxn and gait not assessed pertinent results: labs on admission: . 02:00pm blood wbc-11.7* rbc-4.17* hgb-12.0 hct-35.5* mcv-85 mch-28.9 mchc-34.0 rdw-15.0 plt ct-394 02:00pm blood neuts-70.4* lymphs-24.9 monos-3.6 eos-0.5 baso-0.7 . 02:00pm blood glucose-114* urean-21* creat-1.5* na-130* k-4.4 cl-91* hco3-23 angap-20 . 02:00pm blood alt-11 ast-19 alkphos-95 totbili-0.3 . 08:16pm blood ck(cpk)-12* 02:00pm blood ctropnt-0.01 08:16pm blood ck-mb-3 ctropnt-0.02* 03:44am blood ck-mb-3 ctropnt-0.01 . 02:00pm blood calcium-10.4* phos-2.2* mg-1.4* . labs on discharge: . 06:34am blood wbc-10.4 rbc-3.46* hgb-10.1* hct-29.8* mcv-86 mch-29.0 mchc-33.8 rdw-15.6* plt ct-458* 06:34am blood pt-22.5 --> 19.4*, ptt-38.5*, inr(pt)- 2.1 --> 1.8* 06:34am blood glucose-87 urean-12 creat-1.4* na-133 k-4.1 cl-100 hco3-25 angap-12 06:34am blood calcium-9.0 phos-3.3 mg-1.2* . microbiology: urine cx (): escherichia coli. sensitivities: mic expressed in mcg/ml ________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . blood cultures and fungal cultures - no growth to date . c. diff toxin - negative . imaging: . cxr (): impression: no evidence of acute cardiopulmonary process. . ct head (): impression: no acute intracranial process. . abdominal xr (): impression: mildly dilated loop of small bowel in the left hemiabdomen with paucity of gas in distal bowel. a small bowel obstruction is not excluded. consider ct for further evaluation. . renal u/s (): impression: 1. no hydronephrosis or stones. there is minimal prominence of the right renal pelvis. 2. normal doppler arterial and venous waveforms in the bilateral main renal artery and vein. . ct abdomen/pelvic (): impression: 1. no evidence of hematoma to explain the patient's hematocrit drop. 2. small right and trace left pleural effusions with patchy bibasilar opacities which may represent atelectasis or aspiration/pneumonia. 3. slightly improved anasarca. 4. moderate dilation of the small bowel with thickening of the small bowel folds, which may be due to edema given the patient's anasarca, though the differential is broad. recommend an exam with oral and iv contrast when feasible. . cxr (): there are multiple new opacities seen in the lungs that might be worrisome for multifocal infection in the right lower lobe and left lower lobe. cardiomediastinal silhouette is unchanged. there is no pleural effusion or pneumothorax. the left picc line tip is at the level of superior mid svc. brief hospital course: 68 year old female with history of multiple mdr infections/sepsis in multiple sources (vre, esbl, c. glabrata and parapsilosis in urine, blood, joints), radiation-induced enteritis c/ chemotherapy-associated cardiomyopathy and chronic diarrhea/malabsorption, presents from her rehabilitation center with increased confusion and hypertensive urgency (bps 200s/100s), with development of labile bps, e.coli uti, multiple lung opacities, currently on meropenem (uti) / linezolid (?pna). . ** for abbreviated micu course, please see hpi ** . # id: urine culture grew esbl e. coli, highly sensitive to meropenem. patient was started on meropenem in the micu due to her presentation of acute change in mental status and she was continued on meropenem on the floor. on her cxr before leaving the micu, right and left lower lobe opacities were concerning for pna and ?aspiration. patient developed cough with productive sputum and low-grade , so linezolid was continued. sputum cultures were ordered, but patient was unable to produce a sputum to send to the lab. antibiotic regimen of meropenem/linezolid continued during the hospitalization. she will continue on meropenem only for 3 more days upon discharge. all blood cultures, repeat urine cultures, and c. diff toxins were negative to date. . # labile blood presures: while in the micu, the patient's blood pressures were quite labile and highly sensitive to av nodal blockers (labetalol) with resulting bradycardia and hypotension. she was discontinued on all anti-hypertensives upon transfer to the floor since she became oliguric while hypotensive in the micu. her blood pressures were mostly elevated on the floor and she was uptitrated slowly on captopril to 25mg tid for longer-term bp control without concern for bradycardia. over the few days leading to her discharge, she had much fewer episodes of sbps to 190s and were mostly between the 120s to 160s, signifying much improved control. . #. abdominal pain and diarrhea: chronic issue radiation enteritis. previous gi consult recommended continuing course of opium tincture and lomotil and this was continued on the hospitalization. infectious diarrhea quite unlikely, and c. diff was negative. her abdominal pain and diarrhea continues on discharge, with pain controlled with iv dilaudid every 3 hours. she did not tolerated po dilaudid. . #. hyponatremia: stable around low 130s. patient appeared euvolemic on exam and was likely not hypovolemic, given her good po intake. uosms = 126 with urine na of 47 usually indicates polydipsia, but fluid restriction did not correct serum sodium levels. it is unlikely to be due to lack of na+ intake, since she would be more sodium avid. she continues to remain asymptomatic, but any future mental status could potentially be due to a dropping serum sodium and it should be monitored. . # mental status changes: her initial presentation of mental status changes were likely secondary to hypoperfusion, opioid overdose (given her response to narcan), and possibly uti. her sensorium was clear for the remainder of her hospitalization currently clear mental status, on antibiotic course. . medications on admission: rehab medications: dronabinol 2.5mg carvedilol 25 mg po bid -heparin flush (10 units/ml) 2 ml iv prn line flush -levothyroxine sodium 168 mcg iv daily zoloft 150 mg daily -zolpidem 5 mg po qhs -cyanocobalamin 1,000 mcg tablet qod -opium tincture 10 mg/ml ten (10) drop po q4h prn for diarrhea -miconazole nitrate 2 % powder hydromorphone 4 mg q4h prn for pain -omeprazole 40 mg daily -warfarin 3 mg daily -diphenoxylate-atropine 2.5-0.025 mg 1-2 tablets q8h prn for diarrhea discharge medications: 1. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 2. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for itching. 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. warfarin 1 mg tablet sig: three (3) tablet po once a day. 5. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po every other day (every other day). 6. opium tincture 10 mg/ml tincture sig: ten (10) drop po q6h (every 6 hours) as needed for diarrhea. 7. levothyroxine 200 mcg recon soln sig: one y eight (168) mcg injection daily (daily). 8. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 9. lomotil 2.5-0.025 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for diarrhea. 10. meropenem 500 mg recon soln sig: five hundred (500) mg intravenous q12h (every 12 hours) for 3 days: please take until . 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 12. hydromorphone 2 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 13. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) injection every eight (8) hours as needed for nausea. 14. multivitamin tablet sig: one (1) tablet po daily (daily). 15. captopril 25 mg tablet sig: one (1) tablet po three times a day. tablet(s) discharge disposition: extended care facility: at discharge diagnosis: primary diagnosis: multiple drug resistant urinary tract infection pneumonia hypertension altered mental status radiation-induced enteritis . secondary diagnoses: chronic kidney disease hypothyroidism metastatic ovarian cancer, with chemotherapy and radiation 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: dear mrs. , it was a pleasure treating you at the . you were initially admitted to the intensive care unit after you had some confusion and very high blood pressures at the rehabilitation center. we found that you had a urinary tract infection and we treated it with antibiotics. once your blood pressures were better controlled, you were moved to the general medicine floor. you continued to have abdominal pain and diarrhea, but this was mostly unchanged from before. once your blood pressures were under control and your condition continued to improve, we felt comfortable discharging you back to the rehabilitation center. they will continue physical therapy with you to get your strength up. please be careful not to take too many pain medications, as we think this may have contributed to your confusion. . we have started the following medications, to be administered in the rehab facility: start meropenem 500mg iv twice a day until start captopril 25mg by mouth three times a day start guaifenesin (cough syrup) 100 mg/5 ml syrup, 5-10 mls by mouth every 6 hours as needed for coughing start ondansetron 4mg iv every 8 hours as needed for nausea start taking 1 multivitamin every day . stop dronabinol stop carvedilol . change hydromorphone po 4mg every 4 hours to 2mg every 6 hours as needed for pain followup instructions: in the rehabilitation center, you will be seen by the staff physician. feel free to schedule an appointment with your primary care physician, . , whenever it is convenient for you. procedure: injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified other primary cardiomyopathies urinary tract infection, site not specified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use pressure ulcer, lower back personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits personal history of irradiation, presenting hazards to health late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pressure ulcer, stage ii personal history of malignant neoplasm of ovary gastroenteritis and colitis due to radiation 

Answer: The patient is high likely exposed to