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: bilateral ureteral obstruction major surgical or invasive procedure: bilateral stent removal (complicated), bilateral stent placement and bilateral retrograde pyelogram readings, cystolitholapaxy. dr. . . history of present illness: 69 year old male with a history of high grade invasive transitional call carcinoma of the bladder s/p lap cystectomy and neobladder formation and multiple complications including atrial fibrillation with rapid ventricular response and bacteremia presenting for elective bilateral ureteral stent change. he has had bilateral nephrostomy placements in the past few months for obstructive pyelonephritis and sepsis. since then, the pcn's were internalized to jj ureteral stents. he has also undergone ureteral balloon dilation by interventional radiology. past medical history: 1. h/o mi - 17 yrs ago, treated at hospital, per patient treated with a "clot busting medication" (possibly tpa), hospitalized x 6 days and discharged. as noted previously, he did not take medications after discharge and did not follow up with any physicians 2.paroxysmal atrial fibrillation, discovered at time of cancer diagnosis , difficult to control post-operatively . has recurrences of af/rvr during last hospitalization. 3.high-grade invasive transitional cell carcinoma 4.osteoarthritis of ankles 5.c. difficle colitis 6. klebsiella bacteremia (last ) with klebsiella uti 7. gastritis/duodenitis 8.left percutaneous nephrostomy tube for presumed obstructive uropathy. 9.right percutaneous nephrostomy tube, emergent, for obstructed pyelonephritis. social history: -married and lives with wife in . retired, worked as a construction worker. -smoking: 30+ py, quit before -etoh: denies -drugs: denies family history: -mother died at yrs. -father died in early 70's from asbestosis pertinent results: 07:10am blood wbc-7.6 rbc-3.51* hgb-10.0* hct-29.8* mcv-85 mch-28.4 mchc-33.6 rdw-18.1* plt ct-76*# 12:19pm blood wbc-32.0* rbc-3.61* hgb-10.4* hct-31.7* mcv-88 mch-28.8 mchc-32.9 rdw-18.1* plt ct-73* 07:10am blood glucose-76 urean-101* creat-4.7* na-142 k-4.0 cl-111* hco3-21* angap-14 03:44pm blood glucose-99 urean-103* creat-5.8* na-133 k-4.1 cl-93* hco3-20* angap-24* 06:40am blood wbc-7.9 rbc-3.61* hgb-10.2* hct-31.6* mcv-87 mch-28.2 mchc-32.2 rdw-18.7* plt ct-165# 06:02am blood wbc-6.6 rbc-3.46* hgb-9.9* hct-29.0* mcv-84 mch-28.6 mchc-34.1 rdw-17.8* plt ct-96* brief hospital course: pt was admitted to dr. urology service after undergoing bilateral stent change. the patient was scheduled for day surgery, but became hypotensive, tachycardic in the day surgery pacu, requiring pressors. the patient was transferred from the pacu to the icu. icu course was significant for: # sepsis mr. was admitted to the icu in septic shock after bilateral ureteral stent change. he had an elevated lactate, rising white blood cell count, fevers and hypotension not responsive to fluids. he has a history of chronic infection in the gu tract, in addition to vre colonization. he has been admitted for severe sepsis after gu procedures on multiple occasions since his neobladder surgery in . on admission to the icu, the patient was requiring multiple pressors and was started on treatment with linezolid and zosyn. he was slowly weaned off pressors and transferred back to the urology service when hemodynamically stable. # atrial fibrillation the patient presented to the icu from the pacu with heart rates in the 130s-150s, which appeared consistent with prior post-op course and contributing to his hypotension. triggers, likely multifactorial, likely included post-op stress, hypovolemia, and infection. he was started on an amiodarone drip, which controlled his rhythm. prior to transfer back to the urology service, he was started on low-dose beta-blocker, which is to be increased back to his home dose of metoprolol prior to discharge from the hospital. an echo showed that his left atrium is mildly dilated, and there is mild symmetric left ventricular hypertrophy with normal cavity size. he has some mild regional left ventricular systolic dysfunction with inferior hypokinesis. # acute renal failure mr. was in rapidly worsening acute renal failure post-operatively with oliguria and hyperkalemia, most likely from acute tubular necrosis secondary to hypotension. a renal ultrasound showed no concern for obstructive post-renal etiology. lasix boluses were used to increase his urine output and keep his potassium in check. prior to transfer from the icu, the patient started autodiuresing, and his kidney function began to slowly improve. # diarrhea the patient presented with stool incontinence. due to history of severe c. difficile infection, he was treated empirically with metronidazole and per oral vancomycin. his stool was negative for c difficile during this hospitalization. on pod 7, the patient was transferred to the floor in stable condition. on pod 8, the foley catheter was removed and the patient continued to be incontinent as he was prior to admission. he was discharged in stable condition on pod 10, creatinie trending down, wbc normal, with a picc line in place for 13 more doses of zosyn and oral vancomycin to be taken for two days following zosyn. vna services were arranged for the administration of antibiotics and subsequent removal of picc line and in home physical therapy. he was instructed to follow up with renal on and provided a lab order slip (per renal recs) for a chem 10 to be drawn on at the clinical center. he was instructed to contact dr. office upon discharge to arrange/confirm follow up appointment. medications on admission: metoprolol 100 mg po daily warfarin 2 mg po daily vit d2 800 units daily oxycodone-acetaminohpen 5mg-325mg one tab q6h prn discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 3. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 6. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 5 days: administer daily iv antibiotics as prescribed until finished. disp:*13 recon soln(s)* refills:*0* 7. vancomycin 250 mg capsule sig: two (2) capsule po q8h (every 8 hours) for 7 days: take as prescribed until finished. disp:*42 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: bilateral ureteral stricture status post bilateral stent removal, bilateral stent placement. discharge condition: stable discharge instructions: -you may shower and bathe normally. -tylenol should be your first line pain medication, a narcotic pain medication has been prescribed for breakthough pain >4. replace tylenol with narcotic pain medication. max daily tylenol dose is 4gm, note that narcotic pain medication also contains tylenol (acetaminophen) -do not drive or drink alcohol while taking narcotics -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops. -resume all of your home medications, no changes. -take the antibiotics as prescribed for the full course (vancomycin and zosyn). dosing is scheduled at midnight, 8am and 4 pm, if at all possible please continue with this schedule. -please do clean intermittent catheterization daily with flushing as instructed. -please return to clinical center next week to have labs drawn to evaluate your renal function -please follow up with renal as scheduled (see below) -call dr. office to schedule a follow-up appointment and if you have any urological questions, . -if you have fevers > 101.5 f, vomiting, severe abdominal pain, or inability to urinate, call your doctor or go to the nearest emergency room. definitions: ureter: the duct that transports urine from the kidney to the bladder: stent: a plastic hollow tube that is placed into the ureter, from the kidney to the bladder to prevent the ureter from swelling shut. despite the fact that no skin incisions were used, the area around the ureter and bladder is irritated. the stent is required in order keep the ureter open and urine flowing from the kidney to the bladder. because one end of the ureter is in the bladder, it can cause irritation to the bladder. therefore, it is normal to feel that you need the urge to urinate frequently when the stent is in place. although the stent can be uncomfortable, it is important to have the stent to avoid damaging the kidney and ureter after your procedure. you may see some blood in your urine while the stent is in place and a few days afterward. drink lots of fluid - this will help clear up your urine. diet: you may return to your normal diet immediately. because of the raw surface of your bladder, alcohol, spicy foods, acidy foods and drinks with caffeine may cause irritation or frequency and should be used in moderation. to keep your urine flowing freely and to avoid constipation, drink plenty of fluids during the day (8 - 10 glasses) activity: your physical activity doesn't need to be restricted. however, if you are very active, you may see some blood in the urine. we would suggest to cut down your activity under these circumstances until the bleeding has stopped bowels-it is important to keep your bowels regular during the postoperative period. straining with bowel movements can cause bleeding. a bowel movement every other day is reasonable. use a mild laxative if needed, such as milk of magnesia tablespoons, or 2 dulcolax tablets. call if you continue to have problems. if you had been taking narcotics for pain, before, during or after your surgery, you may be constipated. take a laxative if necessary medication-you should resume your pre-surgery medications unless told not to. in addition you will often be given an antibiotic to prevent infection. these should be taken as prescribed until the bottles are finished unless you are having an unusual reaction to one of the drugs. problems should report to urology service a. fevers over 100.5 fahrenheit b. heavy bleeding, or clots (see notes above about blood in urine). c. inability to urinate. d. drug reactions (hives, rash, nausea, vomiting, diarrhea). e. severe burning or pain with urination that is not improving. f. you have and internal stent and it is important to have a follow-up appointment to remove your stent. call your doctor for this appointment when you get home followup instructions: call dr. office to schedule a follow-up appointment and if you have any urological questions, . renal follow up- provider: , md phone: date/time: 12:45 procedure: venous catheterization, not elsewhere classified ureteral catheterization retrograde pyelogram transurethral clearance of bladder injection or infusion of oxazolidinone class of antibiotics diagnoses: acidosis thrombocytopenia, unspecified other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified atrial fibrillation septic shock personal history of malignant neoplasm of bladder streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus other and unspecified coagulation defects diastolic heart failure, unspecified stricture or kinking of ureter 

Answer: The patient is high likely exposed to