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: patient recorded as having no known allergies to drugs attending: chief complaint: biliary stent removal major surgical or invasive procedure: ercp with removal of previuosly placed biliary stent history of present illness: this is a 75 year-old man with history of gallstone pancreatitis/gangrenous cholecystitis s/p cholecystectomy on subsequently complicated by cystic duct stump bile leak requiring ercp with stenting on , ards/acute lung injury presumed secondary to pancreatitis, left pneumothorax requiring chest tube, sepsis, atrial fibrillaiton, and respiratory failure requiring prolonged mechanical ventilation now s/p trach on . he now has persistent ventilator dependent respiratory failure. he is admitted for removal of the biliary stent placed on . patient currently under care at hospital. currently, by report his is vent dependent and has had persistent cuff leak issues. currently with cuff pressure of 30 mmh and needs 8-9 cc of air in balloon to prevent leak. trach recently changed to 8 cuffed tube. his mental status is responsive with eye contact but with general apathy and poorly responsive to stimuli. no pain issues and on no sedation. had recent funguria with for which he is maintained on flucanozole with his course scheduled to finish on and receiving q shift baldder irrigation. also with recent klebsiella pneumonia. completed antibiotic course for this. his nutritional status is tenuous as he has had difficulty with diarrhea complicating his tubefeeds and required augmentation with tpn, baseline albumin about 1.7 maintained on flagyl for the diarrhea, despite being repeatedly c. diff negative. flagyl also scheduled to end on . patient has chronic anemia with baseline about 30, has been guiac negative. grade 3 sacral decub. no issues with recent a fib. on admission, patient denies all pain. past medical history: - complicated lap chole for gallstone cholecystitis, hospital. post op course complicated by hypoxia (intubated, ards, afib, l pneumothorax, s/p chest tube, and biliary leak (bilious ascities). - admitted to for emergent ercp for bile leak from cbd. stent placed to cbd. -h/o mi, lbbb -s/p trach , s/p ards and persistent ventilator dependent respiratory failure, persistent cuff leak with cuff pressure 20 mm hg and 8-9 cc air to prevent leak. frequent bloody secretions. possible pressure tracheomalacia per ent. ventilated on ac 600 x 16 peep 12, fio2 55% - bronch bleeding lul upper division with clot . no endobronchial lesion . -with any turning pt desats to high 80s -recent kleb pna, currently cx negative. -poor nutritional status, on elemental tf. recently on tpn, but recently stopped as tf at goal. tf 3/4 strength at 85 -baseline ms: responsive with eye contact, but generally apathetic -on flagyl for diarrhea, c diff neg at osh. -funguria: c. albicans. bladder irrigation q shift and tx with flucon. -intermittent rapid afib, echo : severe lv dysfunction rv hypokinesis, mod mr/tr -grade 3 sacral decubiti -fluconazole and flagyl course should end . -admit wt 203 lbs -hard of hearing, use r ear social history: ? former smoker, retired carpenterpcp dr. now in process of getting court appointed guardian, as no family members family history: unknown. physical exam: vs: t 98.4 hr 89 bp 110/65 rr 14 98% ac 600 x 14 fio2 55% peep 12 gen: responds to voice, nods head yes and no, + trach heent: perrl, eomi, +ngt (dobhoff), +trach-no leakage neck: supple chest: coars bs bilaterally cv: rrr abd: distended, soft, nt, + bs ext: 1+ edema to knees bilat, +l scl: cdi, +l a line: cdi neuro: eomi, moves all 4 extremities pertinent results: most recent labs from : hct 31.1 wbc 17, na 137, cl 112, hco3 22, bun 61, cr 0.8, glu 127, ca 7.4, mg 1.9, phos 3.9, alb 1.4 admit labs: 07:38pm wbc-16.4* rbc-3.53* hgb-10.3* hct-33.4* mcv-95# mch-29.2 mchc-30.8* rdw-19.2* 07:38pm plt smr-high plt count-479*# 07:38pm neuts-73* bands-1 lymphs-11* monos-15* eos-0 basos-0 atyps-0 metas-0 myelos-0 07:38pm glucose-145* urea n-65* creat-0.8# sodium-142 potassium-5.0 chloride-109* total co2-22 anion gap-16 07:38pm albumin-2.4* calcium-8.1* phosphate-4.0# magnesium-1.8 07:38pm pt-15.0* ptt-29.4 inr(pt)-1.4 cardiac enzymes: 07:38pm ck-mb-5 ctropnt-0.20* abg on admit: 07:59pm type-art rates-16/23 tidal vol-600 o2-55 po2-60* pco2-39 ph-7.37 total co2-23 base xs--2 -assist/con intubated-intubated ekg: lbbb chest x-ray : clinical indication: intubated. question ards. since the prior chest radiograph, there has been interval placement of a tracheostomy tube. a left subclavian vascular catheter is present, in satisfactory position, and a feeding tube terminates below the diaphragm. the heart demonstrates left ventricular configuration. there is prominence of the pulmonary vascularity, and there are diffuse bilateral hazy areas of increased opacity with slightly more confluent consolidation centrally in the lungs. there are probable layering pleural effusions bilaterally. impression: new diffuse pulmonary opacities, most prominent centrally. the appearance favors pulmonary edema, but the differential diagnosis includes diffuse infection and ards. chest x-ray : indication: a 75-year-old male with ards, pancreatitis. technique: portable ap chest radiograph. the comparison is made with a prior chest radiograph dated . findings: the patient is status post tracheostomy. left subclavian venous catheter is unchanged compared to the prior study. the cardiac and mediastinal contours are unchanged compared to the prior study. again, note is made of bilateral patchy parenchymal opacities, slightly improved compared to the prior study, especially in right lower lobe. persistent diffuse hazy opacities noted, representing pulmonary edema. continued left lower lobe opacification is noted, representing pneumonia versus atelectasis. continued pleural effusion is noted. mild chf is noted, slightly decreased compared to the prior study. impression: improvement of multiple patchy opacities in bilateral lungs, especially in right lower lobe, associated with edema, effusion, and persistent opacification of left lower lobe. improving chf. urine: 12:56pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 12:56 pm urine urine culture (preliminary): gram negative rod(s). >100,000 organisms/ml. further identification to follow. sensitivities: mic expressed in mcg/ml gram negative rod(s)---pending | sputum: 4:04 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs and chains. respiratory culture (preliminary): sparse growth oropharyngeal flora. gram negative rod(s). sparse growth. predominating organism. further identification to follow. sensitivities: mic expressed in mcg/ml gram negative rod(s)-pending discharge labs: 09:19a pt: 15.1 ptt: 27.3 inr: 1.4 04:20a na:146 cl114 bun: 44 gluc92 agap=13 pot:4.3 bicarb 23 creatinine0.8 ca: 7.6 mg: 1.9 p: 3.5 wbc17.2 hemoglobin9.8 platelets476 crit:31.5 blood cultures sent, pending on . brief hospital course: assessment: 75m s/p lab chole c/b cbd leak, bilious ascites, respiratory failure and inablitiy to wean from vent. pt now admitted for stent removal from cbd. the following issues were addressed on this admission. . concerning his biliary stent: the patient was transferred for removal of biliary stent placed on for cystic duct stump leak. removal of stent was delayed because of consent issues and then because of serviving of ercp equipment. stent was successfully removed without complication on am. he was followed by gi/ercp on this admission. received amp/gent before procedure. no bleeding complications with procedure but had inr of 1.4-would give vitamin k at any sign of bleeding/crit drop. concerning his respiratory failure: felt secondary to ards secondary to pancreatitis/sepsis after his gangrenous cholecystitis/pancreatitis in early . also, most recently had recent kleb pna at . bronched at on and found to have some bleeding and bloody secretions. no acute issues while at . he was generally maintained on similar vent setting as at . had sputum sent which was positive for gpc in pairs and chains by stain and gnr on culture. given clinical stability, did not treat, no other evidence of vap. no increased secretions, no fevers and no change on chest x-ray. patient was continued on ac mechanical ventilation with most recent vent settings of ac 600 x 14 p12, fio2 55%. he was gently diuresed about 1.5 liters while at . concerning his leukocytosis/low grade fevers: white count essentially stable throughout course. has had low grade fevers with high to 101.2 on am. sputum as noted above with gpc on stain, gnr on culture, but no clinical respiratory change or change on plain films and thus not treating. also sent urine on as patient with known funguria at and his course of antibiotics completed on (fluconazole). urine culture came back gnr on am and cipro was started. blood cultures were sent with spike on , pending negative on discharge. lines were re-sited on am. right subclavian placed as well as new a-line. concerning his cardiovascular issues: concerning ischemia: patient with history of mi, recent tropinin leak at . aspirin and metoprolol were maintained. concerning pump function: patient with recent echo: severe lv dysfunction and rv hypokinesis mod mr/tr. patient maintained on beta-blocker. added low dose ace-captopril 6.25 tid. could consider change to lisinopril 5. gently diuresed on about (1.5 liters negative over course of admission.) concerning rhythm issues: history of atrial fibrillation. patient was in nsr throughout admission. he was maintained on metoprolol with good rate control. no anti-coagulation given recent concern for bloody secretions. concerning his id issues: patient with funguria at : scheduled to end course of fluconazole . course was completed and now is off fluconazole. bladder washings continued. also completed course of flagyl. see fevers/leukocytosis above. patient with history of diarrhea: admitted on flagyl scheduled to end course , not c. diff + at osh. patient's course of flagyl was completed on , and now currently off flagyl. has not had diarrhea here, but npo for most of the admission pending the possible ercp. tubefeeds re-started prior to discharge patient with sacral decub: dressing changes, desitin, vit c, zinc, were maintained. no acute issues. maximize nutrition as possible. patient's mental status was unchanged throughout this admission from his baseline. his code status was full throughout admission. he was maintained on ppi and heparin subcu for gi and dvt prophylaxis respectively his access: right subclavian placed on and a-line placed on . patient is discharged in stable condition. medications on admission: lopressor 37.5 mg ngt insulin ss asa 325 mg po qd zantac elixir 150 mg ngt heparin 5000 fluconazole 200 mg ngt qd flagyl 500 mg ngt tid bladder irrigation 60 cc tid ferrous sulfate ngt h2o flush 60 cc qid lasix prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 3. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 5. ascorbic acid 100 mg/ml drops sig: two (2) po daily (daily). 6. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 7. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 8. collagenase 250 unit/g ointment sig: one (1) appl topical (2 times a day). 9. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 10. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 11. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 12. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 13. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. discharge disposition: extended care discharge diagnosis: respiratory failure, biliary stent removal discharge condition: stable discharge instructions: patient to be discharged to hospital. further care as per physicians at . followup instructions: as per doctors hospital. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances removal of t-tube, other bile duct tube, or liver tube endoscopic retrograde cholangiopancreatography [ercp] diagnoses: urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site pressure ulcer, lower back hyperosmolality and/or hypernatremia pneumonia due to klebsiella pneumoniae tracheostomy status 

Answer: The patient is high likely exposed to