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 / bactrim ds / cefazolin attending: chief complaint: pyelonephritis, septicemia major surgical or invasive procedure: none history of present illness: 70 year old female who presents with 2 weeks of dysuria, who called her pcp 1 day prior to presentation and was given a prescription for ciprofloxacin. the urine culture returned an e. coli resistant to cipro, and she was changed to macrobid. she now presents with fever to 103.1, chills, nausea, vomitting and malaise. on presentation she was also hypoxic at 88% requiring 4l of oxygen via nasal cannula. a ct abdomen in the ed was notable for perinephric stranding. patient notes she is anaphylactic to penicillin and sulfa drugs. she was given ivf and levaquin and flagyl. of note, patient is very anxious/tearful as she is giving a speech next week at the aniversary as her relative died in . ros: gen: + fevers, + chills, - weight loss, + malaise eyes: - photophobia, - visual changes heent: - oral/gum bleeding cardiac: - chest pain, - palpitations, - edema gi: + nausea, + vomitting, - diarhea, + abdominal pain, - constipation, - hematochezia pulm: + dyspnea, - cough, - hemoptysis heme: - bleeding, - lymphadenopathy gu: + dysuria, - hematuria, - incontinence skin: - rash endo: - heat/cold intolerance msk: - myalgia, - arthralgia, - back pain neuro: - numbness, - weakness, - vertigo, - headache past medical history: morbid obesity depression osteoarthritis varicose veins edema uterine cancer status post tah papillary thyroid cancer status post resection in bilateral knee replacement, and shoulder surgery social history: lives with her boyfriend in with involved family in the area currently employed as a travel consultant. denies smoking or drug use drinks approximately 1 drink/month family history: non-contributory physical exam: physical exam: vss: 98.6, 120/70, 90, 18, 95% gen: uncomfortable, morbidly obese pain: 0/10 heent: eomi, mmm, - op lesions pul: crackles lll, good air movement cor: rrr, s1/s2, - mrg abd: nt, obese, +bs, + r cvat ext: - cc, chronic venous stasis changes, b/l le edema neuro: caox3, anxious pertinent results: outside lab urine culture: urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 8 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r (r) 04:10am blood wbc-13.8* rbc-4.36 hgb-11.7* hct-36.5 mcv-84 mch-26.7* mchc-31.9 rdw-13.4 plt ct-217 04:10am blood neuts-91.7* lymphs-5.4* monos-1.7* eos-0.9 baso-0.3 04:10am blood pt-11.8 ptt-25.3 inr(pt)-1.0 04:10am blood glucose-145* urean-18 creat-0.8 na-138 k-4.3 cl-99 hco3-28 angap-15 04:10am blood alt-21 ast-25 ld(ldh)-226 alkphos-121* totbili-0.7 04:10am blood lipase-23 04:10am blood albumin-4.0 calcium-9.2 phos-3.3 mg-1.9 05:21am blood lactate-2.8* 07:10am urine color-yellow appear-clear sp ->1.030 07:10am urine blood-neg nitrite-pos protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-sm 07:10am urine rbc-0-2 wbc-21-50* bacteri-few yeast-none epi-0-2 imaging: cxr right basilar opacification may represent atelectasis versus early pneumonia. ct abd/pelvis 1. no evidence of intraabdominal abscess as questioned. 2. hepatic steatosis. slight increase size of hypoattenuating segment ivb liver lesion. this is not fully characterized, although one consideration would be focal fatty infiltration. recommend op mr for further characterization. 3. sigmoid diverticulosis without evidence for acute diverticulitis. unchanged small hiatal hernia. 4. stable pelvic lymphadenopathy of unknown etiology. 5. unchanged mild perinephric fat stranding and parapelvic renal cysts. portable cxr worsening chf. an underlying infectious infiltrate in the lower lobes cannot be excluded. echo the left atrium and right atrium are normal in cavity size. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. 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 (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. compared with the report of the prior study (images unavailable for review) of , the findings are grossly similar. prelim ct-abdomen/pelvis: no abscess diverticulosis no diverticulitis small hiatal hernia persistent perinephric stranding brief hospital course: 70yo female with a history of hypertension was admitted with urosepsis and hypoxia requiring a brief icu stay. 1. urosepsis the patient's initial presentation was notable for temp 103, rr to 30, and tachycardia to 135. given her history of a urinary tract infection as an outpatient, her presentation was most concerning for urosepsis. her blood and urine cultures grew quinolone resistant e. coli. likewise, she was diagnosed as an outpatient with a quinolone-resistant e. coli uti for which she was prescribed macrobid, but she did not fill this prescription. due to her multiple allergies, aminoglycosides were the antibiotic of choice. she was started on tobramycin and was discharged to complete a 2 week course of tobramycin. her kidney function and hearing during her hospitalization were both unremarkable. she was recommended to have cbc, renal function, tobramycin levels, and hearing monitored with her primary care physician and visiting nurse from the hospital. 2. hypoxia: shortly after arrival to the floor from the emergency department where she received 2l ivf, she was noted to be hypoxic, requiring icu transfer. she was gently diuresed and was then called out to floor. she was discharged on room air. repeat echocardiogram was generally unchanged from her previous echo in . 3. hypertension as an outpatient, she takes hctz and diovan. her anti-hypertensive regimen was initially held and then gradually restarted after being called out from the icu. her valsartan was resumed at her home dose, and her hctz was resumed at 1/2 dose. she was recommended to follow-up with her pcp within one week. at that visit, we recommend that her hctz be returned to her full dose if her blood pressure allows. she was continued on her home regimen for hypothyroidism. medications on admission: macrobid 100 mg cap one po bid (not taken) prilosec 20 mg cpdr one po bid percocet tab 5-325mg po q 6 hr prn pain naproxen tab 500mg one pill twice daily as needed with food vitamin d iu caps 1 every week for 8 wks, then every 1st of the month hydrochlorot tab 12.5mg daily diovan hct 80-12.5 mg tabs one po qd levoxyl 200 mcg daily except sunday, then 300mcg medications: 1. tobramycin sulfate 40 mg/ml solution sig: two y (220) mg injection q12h (every 12 hours) for 9 days. disp:*3960 mg* refills:*0* 2. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 3. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 4. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 5. outpatient lab work please check cbc, bun, creatinine, and tobramycin peak on . please fax these results to dr. office at . 6. outpatient lab work please check bun and creatinine on and have these results faxed to your primary care doctor's office at . 7. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disposition: home with service facility: home therapies diagnosis: primary diagnosis: 1. urinary tract infection, bacterial 2. e. coli bacteremia 3. pulmonary edema secondary diagnoses: 1. anxiety 2. hypertension condition: stable. patient is ambulating, tolerating oral intake, and has returned to her baseline condition. instructions: you were admitted to the hospital with urinary tract infection that spread to your blood. you were started on antibiotics to treat this infection and have improved. you also developed shortness of breath due to your need for intravenous fluids, but your breathing has also remarkably improved. we have made the following changes to your medications: - tobramycin - this is an antibiotic to treat your urinary tract infection and blood infection. this should be continued through . this infection can cause hearing problems and kidney damage. you will be monitored for both of these problems with the help of your visiting nurse and primary care physician. hctz - we have decreased this dose from 25mg daily to 12.5mg daily. we have recommended that you follow-up with your primary care dose and this medication can be returned to your regular dose once you have finished your tobramycin. please seek immediate medical attention if you develop fevers, shaking chills, nausea, vomiting, fatigue, malaise, shortness of breath, or changes in your hearing. followup instructions: provider: , md phone: date/time: 8:20 please follow-up with your primary care doctor dr. within 1-2 weeks of your from the hospital. dr. office should be calling you with an appointment within the next 2-4 days. procedure: venous catheterization, not elsewhere classified diagnoses: unspecified acquired hypothyroidism depressive disorder, not elsewhere classified sepsis personal history of malignant neoplasm of other parts of uterus morbid obesity personal history of noncompliance with medical treatment, presenting hazards to health septicemia due to escherichia coli [e. coli] hip joint replacement acute edema of lung, unspecified personal history of malignant neoplasm of thyroid benign essential hypertension acute pyelonephritis without lesion of renal medullary necrosis 

Answer: The patient is high likely exposed to