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: sulfa (sulfonamide antibiotics) attending: chief complaint: altered mental status, fever major surgical or invasive procedure: suprapubic catheter changed on history of present illness: 52 yo f with pmh of ms, and recurrent utis resulting in ams who was brought in from nursing home for altered mental status and fever of 103f. today, she was less responsive at her nf. of note, her baseline mental status is unclear. she denies headache, chest pain, shortness of breath, dysuria, abdominal pain, nausea, vomiting. in the ed, initial vs were: t 99.8 hr 131 bp 96/60 r 18 sao2 94%. initial ua: ph 6.5, large leuk, pos nitrites, rbc >182, wbc >182. wbcs 24.9, pmns 92.0%. initial chemistry unremarkable. anion gap of 15. lactacte was 2.3 and 2.4 after 2l ivf. given vancomycin 1g iv, cefepime 2g iv and tylenol. blood and urine cultures were sent. on arrival to the micu, t:99 bp:122/76 p:118 r:26 o2: 96% on ra. pt alert, oriented to person, in no acute distress. past medical history: - advanced secondary progressive multiple sclerosis - neurogenic bladder with recurrent urinary tract infections - ms-related - history of failure to thrive social history: 21-year-old son at college, going through divorce. father is her hcp. she lives at green center. all of her fellow residents have ms at different stages. some higher functioning residents are allowed to self medicate. she is unable to transfer from bed to chair or walk. she requires assistance for all of her adls and is wheelchair bound. the direct number for her primary nurse - this is the nurse's cell phone number. she encourages all of her providers to call day or night. family history: she is not able to tell about her family history. physical exam: admission exam: vitals: t:99 bp:122/76 p:118 r:26 o2: 96% on ra general: wearing eye patch on left eye. alert, oriented to person only, no acute distress. answers questions in short phrases only heent: sclera anicteric, mmm, oropharynx clear, left eye deviates to left visual field. perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: poor inspiratory effort, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: suprapubic catheter draining bloody, cloudy urine. catheter insertion site slightly erythematous, yet nontender. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 4/5 strength lue, 3/5 strength rue and lower extremities. hyperreflexic throughout. gait deferred. speech is slow and garbled at times. oriented to person only. discharge exam: vitals: 98.6; 117/81; 89; 18; 99ra general: wearing eye patch on left eye. alert, oriented to person only, no acute distress. answers questions somewhat appropriately, interactive, pleasant gu: suprapubic catheter clear urine. catheter insertion site wihtout erythematous, nontender. exam otherwise unchanged since admission pertinent results: admission labs: 10:09am glucose-104* urea n-8 creat-0.7 sodium-144 potassium-3.7 chloride-112* total co2-26 anion gap-10 10:09am calcium-7.8* phosphate-1.8* magnesium-1.5* 10:09am wbc-19.2* rbc-3.90* hgb-11.3* hct-34.6* mcv-89 mch-29.1 mchc-32.7 rdw-12.4 10:09am plt count-256 10:09am pt-39.5* ptt-48.4* inr(pt)-3.9* 03:25am lactate-2.4* 01:05am lactate-2.3* 01:00am wbc-24.9*# rbc-4.44 hgb-12.9 hct-39.0 mcv-88 mch-29.0 mchc-33.0 rdw-12.7 01:00am urine blood-lg nitrite-pos protein-100 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-lg 01:00am urine rbc->182* wbc->182* bacteria-many yeast-none epi-0 01:00am urine wbcclump-few mucous-few discharge labs: 07:27am blood wbc-8.2 rbc-3.80* hgb-11.2* hct-33.7* mcv-89 mch-29.6 mchc-33.3 rdw-12.6 plt ct-283 07:27am blood pt-21.6* ptt-36.4 inr(pt)-2.1* 07:27am blood glucose-102* urean-6 creat-0.7 na-144 k-3.8 cl-108 hco3-29 angap-11 07:27am blood calcium-8.4 phos-2.4* mg-1.9 microbiology: 1:00 am blood culture sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). 1:00 am urine urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. blood cultures no growth at the time of discharge imaging: : the lungs appear clear. there has been interval resolution of prior right basilar opacity. no confluent opacity is identified. there is mild prominence of the central pulmonary vasculature, though no overt interstitial edema. no large pleural effusion is evident. there is no pneumothorax or pneumomediastinum. cardiomediastinal and hilar contours are within normal limits. impression: no acute cardiopulmonary process brief hospital course: 52yo f with pmh ms, ms , neurogenic bladder with suprapubic catheter and recurrent utis who presents with uti and sepsis from pan-sensitive e. coli bacteremia. # e. coli bacteremia/sepsis: patient with longstanding hx of neurogenic bladder, suprapubic catheter and recurrent utis presenting with uti and tachycardia, hypotension, fever. hypotension and tachycardia responded to ivf and pt did not require pressors. she was treated broadly with vancomycin and cefepime and bp stable prior to transfer to floor. blood culture from grew pan-sensitive e. coli and patient was switched to po cipro after bcx >48 hours negative. discharged on po cipro for a 14-day course (last day ) # uti: patient known to have recurrent complicated utis in the setting of her indwelling catheter. ua suggestive of uti at rehab day prior to admission, was started on cefpodoxime empirically and received 2 doses however clinically worsensed so broadened to vancomycin and cefepime on admission. suprapubic catheter was changed on . urine cx showed mixed flora, but likely culprit would be pan-sensitive e. coli from her blood culture. abx narrowed to cipro prior to discharge (see above). # ams: likely sepsis, improved back to baseline with treatment as above. # ms: pt followed by neurology for progressive ms. baclofen initially held in the setting of hypotension and restarted on tarnsfer to floor. # recent pe: prior pe in , was supposed to be on 6 month course. given starting ciprofloxacin, would monitor inr more closely. inr on was 2.1. plan to recheck on . please address discontinuing anticoagulation as outpatient. # depression: continued venlafaxine. # osteoporosis: continued calcium (has alendronate also weekly). # constipation: continued her home bowel regimen. # intertrigo: continued nystatin topical powder on groin area. # communication: patient & hcp patient's father ( # code: dnr/dni during admission # new medication: ciprofloxacin (stopped cefpodoxime) # pending studies: blood cultures from and no growth at the time of discharge # follow up: at medications on admission: preadmission medications listed are correct and complete. information was obtained from nh med rec. 1. venlafaxine xr 37.5 mg po daily 2. oxybutynin 15 mg po daily 3. cefpodoxime proxetil 100 mg po q12h 4. acetaminophen 325 mg po q8h:prn pain/fever 5. hibiclens *nf* (chlorhexidine gluconate) 4 % topical daily cleansing 6. warfarin 4.5 mg po daily16 7. docusate sodium 100 mg po bid 8. senna 1 tab po bid 9. azo cranberry *nf* (cranberry ext-c-l. sporogenes) mg-mg-million oral tid supplement 10. bisacodyl 10 mg pr daily:prn constipation 11. milk of magnesia 30 ml po daily:prn constipation 12. alendronate *nf* 70 mg oral qweekly osteoporosis drink with a glass of water. 13. calcium carbonate 500 mg po bid 14. baclofen 15 mg po qid hold for sedation discharge medications: 1. acetaminophen 325 mg po q8h:prn pain/fever 2. baclofen 15 mg po qid hold for sedation 3. bisacodyl 10 mg pr daily:prn constipation 4. calcium carbonate 500 mg po bid 5. docusate sodium 100 mg po bid 6. milk of magnesia 30 ml po daily:prn constipation 7. oxybutynin 15 mg po daily 8. senna 1 tab po bid 9. venlafaxine xr 37.5 mg po daily 10. warfarin 4.5 mg po daily16 11. ciprofloxacin hcl 500 mg po q12h last day 12. alendronate *nf* 70 mg oral qweekly osteoporosis drink with a glass of water. 13. azo cranberry *nf* (cranberry ext-c-l. sporogenes) mg-mg-million oral tid supplement 14. hibiclens *nf* (chlorhexidine gluconate) 4 % topical daily cleansing discharge disposition: extended care facility: center discharge diagnosis: primary: urinary tract infection bacteremia/sepsis secondary: neurogenic bladder with indwelling catheter multiple sclerosis discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: ms. , it was a pleasure taking care of you at . you were admitted because you had an infection in your urine that also went into your blood. we initially treated you with antibiotics through the vein, then changed to oral antibiotics as you improved rapidly. medication changes: started ciprofloxacin 500mg (last day ) stopped cefpodoxime followup instructions: you will continue your care at department: surgical specialties when: monday at 1:30 pm with: , md building: campus: east best parking: garage procedure: replacement of cystostomy tube diagnoses: urinary tract infection, site not specified unspecified septicemia severe sepsis depressive disorder, not elsewhere classified osteoporosis, unspecified long-term (current) use of anticoagulants do not resuscitate status metabolic encephalopathy urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure dementia in conditions classified elsewhere without behavioral disturbance multiple sclerosis accidents occurring in residential institution infection and inflammatory reaction due to indwelling urinary catheter personal history of pulmonary embolism other and unspecified escherichia coli [e. coli] neurogenic bladder nos other specified erythematous conditions attention to cystostomy 

Answer: The patient is high likely exposed to