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: flagyl attending: chief complaint: llq pain major surgical or invasive procedure: placement of a left ureteral stent history of present illness: 64 yo f w/ pmh of chf, iddm, hypothyroidism, ventricular arrythmia with icd who is admitted to the with gnr bacteremia s/p cystoscopy and stent placement for nephrolithiasis with difficulty extubating. pt presented to the ed the day prior to transfer with left flank pain, nausea and vomiting. kub and ct abdomen showed 8-mm stone within the proximal left ureter resulting in mild hydronephrosis. when she was in the ed she got a dose of ceftriaxone and a dose of ampicillin. she was admitted to urology where they were planning to do an elective stent placement. however overnight she developed low grade fevers to 100.8 and her blood cultures grew out gnr and her procedure was moved up to be emergent. she had a stent placed in her left ureter, and she received 700ml fluids total in the or plus 125cc in the pacu. post operatively she remained hypotensive (to unclear bps) on 0.3 of phenylepherine which was weaned off in the pacu. in the pacu when they tried to wean down to extubate, on cpap she was only pulling in tidal volumes in the 100s. she received vanc and cefepime in the pacu. blood sugars were apparently elevated before to unclear levels, got 10u subcu regular noonish. only value recorded is 220s. reportedly good uop while in pacu. she is transferred to the for management of her blood pressure and respiratory status. on arrival to the micu, patient's vs. 99.8 133/69 92 100% on cmv with tv 500, rr 15, fio2 40% review of systems: unable to obtain intubation past medical history: diabetes chf depression diverticulitis hypothyroidism spinal stenosis arthritis obesity ventricular arrhythmia pvd neuropathic pain hx hematuria social history: the patient lives with her daughter. she previously worked as a social worker. she does not smoke or drink alcohol. she has remote cocaine use (quit ) and alcohol use, 45 pack year tobacco hx, quit in . family history: no family history of recurrent skin infections. no family history of premature coronary artery disease or sudden death. father had kidney stones. physical exam: admission physical exam vitals: 99.8 133/69 92 100% on cmv with tv 500, rr 15, fio2 40% general: nad, appears comfortable, aaox3 heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, difficult to assess jvd d/t body habitus cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: dimished breath sounds at bases bilaterally anteriorly abdomen: soft, tender at lower quadrants, maximally on llq, non-distended, no organomegaly, no rebound or guarding. hypoactive bowel sounds. ext: trace edema in feet b/l. warm, well perfused, 2+ pulses, no clubbing, cyanosis pertinent results: kub : impression: 8-mm stone within the proximal left ureter resulting in mild hydronephrosis. ct abd: impression: 7-mm proximal ureteral stone at the level of the l3 vertebral body; upstream left hydroureteronephrosis with delayed excretion of contrast in the dilated left collecting system and proximal ureter. no definite contrast seen in the left ureter distal to the level of the renal stone. cxr : as compared to the previous radiograph, the patient has been intubated. the tip of the endotracheal tube projects 3 cm above the carina. a left pectoral pacemaker is in unchanged position. in the interval, lung volumes have substantially decreased, there are signs indicative of mild-to-moderate pulmonary edema and atelectasis at both lung bases. no evidence of pneumonia. short-term followup with chest radiographs is required. . echo: the left atrium is elongated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with basal to mid inferior and inferolateral hypokinesis. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. compared with the prior study (images reviewed) of , the right ventricle appears dilated and hypokinetic and there is evidence of pressure/volume overload of the left ventricle. findings are suggestive of acute right heart strain - probably from pulmonary embolism although right ventricular ischemia is also possible. . cta chest: impression: 1. no evidence of pulmonary embolism. 2. mild pulmonary edema and bilateral atelectasis, right greater than left. 3. incompletely imaged left kidney showing a 6-mm stone and start of the double j-stent but also small foci of air in the kidney of unclear significance. . microbiology: blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient urine urine culture-final inpatient urine urine culture-final {escherichia coli} emergency urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed skin/genital flora. clinical significance of isolate(s) uncertain. interpret with caution. escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . blood culture blood culture, routine-final {escherichia coli}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . 08:10am blood wbc-5.7 rbc-4.12* hgb-12.4 hct-38.8 mcv-94 mch-30.2 mchc-32.0 rdw-13.6 plt ct-150 08:15am blood wbc-5.9 rbc-3.86* hgb-12.1 hct-36.6 mcv-95 mch-31.3 mchc-33.1 rdw-13.6 plt ct-134* 07:18pm blood hct-37.1 02:44am blood wbc-8.6 rbc-3.93* hgb-12.3 hct-37.1 mcv-94 mch-31.3 mchc-33.2 rdw-13.8 plt ct-122* 12:15pm blood wbc-11.9* rbc-3.95* hgb-12.4 hct-37.4 mcv-95 mch-31.3 mchc-33.0 rdw-14.7 plt ct-144* 07:10am blood wbc-12.4*# rbc-3.83* hgb-11.9* hct-36.2 mcv-95 mch-31.1 mchc-32.9 rdw-13.7 plt ct-140* 11:53am blood wbc-8.2 rbc-4.57 hgb-14.3 hct-43.0 mcv-94 mch-31.3 mchc-33.3 rdw-13.4 plt ct-210 08:15am blood neuts-57 bands-0 lymphs-30 monos-11 eos-1 baso-1 atyps-0 metas-0 myelos-0 02:44am blood neuts-71.9* lymphs-18.4 monos-7.9 eos-1.6 baso-0.3 08:10am blood plt ct-150 08:15am blood plt smr-low plt ct-134* 08:15am blood pt-13.5* ptt-37.1* inr(pt)-1.3* 06:11pm blood pt-14.5* ptt-40.8* inr(pt)-1.4* 02:44am blood plt ct-122* 02:44am blood pt-17.1* ptt-31.8 inr(pt)-1.6* 12:15pm blood plt ct-144* 07:10am blood plt ct-140* 11:53am blood plt ct-210 11:53am blood pt-13.3* ptt-33.5 inr(pt)-1.2* 06:11pm blood fibrino-597* 03:00pm blood glucose-169* urean-14 creat-0.7 na-138 k-4.4 cl-94* hco3-36* angap-12 07:00am blood glucose-151* urean-13 creat-0.7 na-141 k-4.1 cl-95* hco3-44* angap-6* 06:40am blood glucose-186* urean-12 creat-0.9 na-140 k-4.5 cl-94* hco3-46* angap-5* 06:30am blood glucose-143* urean-14 creat-0.8 na-140 k-4.3 cl-95* hco3-40* angap-9 08:15am blood glucose-235* urean-14 creat-0.7 na-136 k-4.5 cl-98 hco3-33* angap-10 02:44am blood glucose-215* urean-13 creat-0.7 na-136 k-4.1 cl-100 hco3-29 angap-11 12:15pm blood glucose-229* urean-19 creat-1.0 na-136 k-4.1 cl-97 hco3-29 angap-14 07:10am blood glucose-241* urean-17 creat-1.0 na-137 k-4.3 cl-99 hco3-30 angap-12 11:53am blood glucose-231* urean-14 creat-0.9 na-140 k-4.3 cl-100 hco3-34* angap-10 03:36pm blood ck(cpk)-176 11:53am blood alt-42* ast-48* alkphos-132* totbili-0.5 11:53am blood lipase-20 03:36pm blood ck-mb-2 ctropnt-<0.01 07:00am blood ctropnt-<0.01 03:00pm blood calcium-9.0 phos-3.7 mg-2.3 06:11pm blood hapto-223* 02:44am blood %hba1c-9.7* eag-232* 06:40am blood tsh-3.3 06:40am blood cortsol-16.9 03:40pm blood type-art temp-37 po2-84* pco2-67* ph-7.39 caltco2-42* base xs-11 intubat-not intuba brief hospital course: 64 yo f w/ complex pmh including systolic chf, dm2, s/p icd, hypothyroidism, osa who was taken to the or urgently for septic nephrolithiasis with ecoli bacteremia who developed post-op hypotension transiently requiring pressors and failure to extubate. . #e.coli urosepsis with obstructive uropathy/nephrolithiasis and hydronephrosis- imaging revealed nephrolithiasis and hydronephrosis. bcx and ucx revealed ecoli. pt was taken to the or for uretral stent placement on ., pt was hypotensive and there was a failure to extubate and pt was admitted to the icu. upon admission to the icu, she was no longer hypotensive and hr was within normal limits. vancomycin and cefepime were initially continued. pt improved and was transferred to the medical floor on . her antibiotics were weaned to iv ceftriaxone given susceptibility pattern. plan is to continue iv antibiotics through . picc line was placed. pt will be following up in urology clinic on for further evaluation and discussion on further treatment of nephrolithiasis and hydronephrosis. of note, pt still with bloody tinged urine. pt will be discharged with the foley catheter in place. would plan for voiding trial and foley removal as soon as urine becomes more clear. #respiratory failure/hypoxia/hypercarbia- patient was intubated for the procedure and likely failed initial weaning because it was initiated when she was still too sedated. she had successful sbt on admission to the icu and was extubated within two hours of admission. however, while on the medical floor, pt was noted to have asymptomatic hypoxemia, often requiring 1-2l nc. pulmonary was consulted and felt as though pt likely has obesity hypoventilation and osa. cpap initiated. pt will be discharged with oxygen nc and cpap with instructions to follow up in pulmonary clinic. of note, pt's echo revealed rv dilation with moderate global free wall hypokinesis. rv pressure overload noted. echo suggesting rv strain. however, cta of the chest was performed on the same day and was negative for pe, showing some mild pulmonary edema. in addition, ekg performed and similar to prior. cardiac enzymes were negative. some atelectasis noted, but no sign of pna. . #systolic heart failure-diuretics, bb, and initially held in icu due to sepsis. lasix, spironolactone and bb restarted. plan to restart upon discharge. tte revealed evidence of pressure overload and cta revealed some pulmonary edema. pt was continued on her home dose of lasix 20mg daily and given an additional dose of 20mg iv lasix on given cta findings. no evidence for ischemia. cta without pe. echo suggested acute rv strain, however, ekg did not reveal ischemia, cardiac enzymes were negative. . #dm: on u500 at home, has not been seen at in over 1 yr. blood sugars here had have been in 200s. was consulted. per their final recommendations: lantus 45units, 15units of standing premeal humalog with humalog sliding scale. pt will need to follow up with upon discharge from rehab or during rehab. . #h/o ventricular arrhythmia: icd in place . #hypothyroidism-continued home levothyroxine 200mcg qday . #depression: continue home meds medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from webomr. 1. bupropion (sustained release) 300 mg po qam 2. citalopram 40 mg po daily 3. fluocinonide 0.05% ointment 1 appl tp apply to legs and feet twice a day, avoid use on face, unerarms, and groin. 4. furosemide 20 mg po daily as needed for sob or swelling. 5. gabapentin 600 mg po daily 6. levothyroxine sodium 200 mcg po daily 7. metoprolol succinate xl 200 mg po daily please hold for sbp <100 or hr <50. 8. nystatin-triamcinolone ointment 1 appl tp :prn rash 9. simvastatin 40 mg po daily 10. spironolactone 25 mg po daily please hold for sbp <100. 11. trazodone 50 mg po hs:prn insomnia please hold for oversedation 12. valsartan 40 mg po daily 13. aspirin 81 mg po daily discharge medications: 1. aspirin 81 mg po daily 2. bupropion (sustained release) 300 mg po qam 3. citalopram 40 mg po daily 4. furosemide 20 mg po daily as needed for sob or swelling. 5. levothyroxine sodium 200 mcg po daily 6. metoprolol succinate xl 200 mg po daily please hold for sbp <100 or hr <50. 7. simvastatin 40 mg po daily 8. spironolactone 25 mg po daily please hold for sbp <100. 9. gabapentin 100 mg po daily 10. ceftriaxone 2 gm iv q24h please prepare in normal saline (no dextrose) given very high blood sugars 11. docusate sodium 100 mg po bid please hold for loose stools 12. oxycodone (immediate release) 5-10 mg po q4h:prn pain hold for sedation 13. senna 1 tab po daily please hold for loose stools 14. fluticasone propionate nasal 2 spry nu daily 15. nystatin-triamcinolone ointment 1 appl tp :prn rash 16. fluocinonide 0.05% ointment 1 appl tp apply to legs and feet twice a day, avoid use on face, unerarms, and groin. 17. polyethylene glycol 17 g po daily 18. valsartan 40 mg po daily this medication was held during admission. please restart and monitor creatinine 19. glargine 45 units breakfast humalog 15 units breakfast humalog 15 units lunch humalog 15 units dinner insulin sc sliding scale using hum insulin discharge disposition: extended care facility: - discharge diagnosis: obstructive nephrolithiasis of the left ureter with gram negative septicemia resulting from this and associated bacterial urinary tract infection. . hypoxemia metabolic acidosis hypercarbia 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 for evaluation of a severe kidney infection causing sepsis. you were found to have a kidney stone and blockage in your kidney due to your kidney stone. you symptoms improved with urinary drainage and antibiotics. . you were noted to have low oxygen levels. for this, you were evaluated by the lung doctors who are recommending that you have an outpatient sleep study and lung function testing. see below. followup instructions: department: surgical specialties when: wednesday at 10:30 am with: urology unit building: sc clinical ctr campus: east best parking: garage . name: , location: /east address: , e/cc-6, , phone: department: pulmonary function lab when: monday at 3:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: monday at 4:00 pm with: dr. /dr. building: sc clinical ctr campus: east best parking: garage department: radiology when: wednesday at 10:20 am with: radiology building: sc clinical ctr campus: east best parking: garage department: podiatry when: thursday at 10:00 am with: , dpm building: ba ( complex) campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube other cystoscopy ureteral catheterization retrograde pyelogram central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism polyneuropathy in diabetes peripheral vascular disease, unspecified personal history of tobacco use depressive disorder, not elsewhere classified sepsis pulmonary collapse paroxysmal ventricular tachycardia acute respiratory failure long-term (current) use of insulin chronic systolic heart failure automatic implantable cardiac defibrillator in situ rheumatoid arthritis obesity, unspecified do not resuscitate status septicemia due to escherichia coli [e. coli] hydronephrosis calculus of ureter knee joint replacement background diabetic retinopathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled mixed acid-base balance disorder benign essential hypertension diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled body mass index 37.0-37.9, adult obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to