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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain major surgical or invasive procedure: endoscopic retrograde cholangiopancreatography (ercp) history of present illness: -year-old male with history of dementia, cad s/p cabg, recent common bile duct stent () for pancreatitic head mass c/b obstructive jaundice, presented with fevers, abd pain, nausea and vomiting. he was initially transferred from his skilled facility to lgh for evaluation of abdominal pain. at lgh, he had a white count of 20.4 with 22% bands, t. bili of 3.1, alt of 100, ast 173, alkaline phosphatase of 273. amylase of 255. patient had a ct scan without contrast showing evidence of a mildly distended gallbladder with numerous stones, the bile stent is in place. he was also noted to have 4.3 cm solid mass exophytic from the left upper renal pole. as well as chronic pleural plaque suggestive of prior asbestos exposure. he was given levaquin and flagyl and transferred here. in the ed, initial vs were: t 97.2, hr 80, bp 98/52, rr 16, svo2 98%. he is nonverbal, guarding noted on exam, lactate of 2.1. he recieved 2l of ivf, surgery saw him in ed recommended ruq us; ercp is to scope tomorrow but will do overnight if unstable. access: 20g r, 18g l on arrival to the micu, patient's vs stable. past medical history: ckd prostate ca cad s/p cabgx3 chf af (no coumadin) htn iddm pancreatic mass s/p palliative stenting vascular dementia scc prostate ca hypothyroidism ckd vte (unk source/location) social history: lives in health and rehab center, currently on hospice. his wife died several months ago code dnr/dni no smoke/drink/drug use daughter and son are and are involved. family history: non-contributory. physical exam: on arrival to micu vitals: 97.6 77 114/58 70 15 98%ra general: non-verbal, mildly distress heent: sclera anicteric, dmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, moaning more when pressing on the belly esp. ruq, + guarding. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: on admission to : ======================== 09:30pm blood wbc-14.4* rbc-3.71* hgb-10.3* hct-33.2* mcv-90 mch-27.9 mchc-31.2 rdw-15.2 plt ct-199 09:30pm blood neuts-94.5* lymphs-2.5* monos-2.4 eos-0.1 baso-0.5 09:30pm blood pt-19.5* ptt-29.8 inr(pt)-1.8* 09:30pm blood glucose-201* urean-27* creat-1.4* na-138 k-4.3 cl-104 hco3-27 angap-11 09:30pm blood alt-97* ast-164* alkphos-284* totbili-2.9* 09:30pm blood albumin-2.8* 09:41pm blood lactate-2.1* ercp: impression: the previously placed plastic stent was identified at the major papilla. the stent was removed with a snare and sent for cytology. the major papilla was very edematous. there was no evidence of prior sphincterotomy. successful biliary cannulation was achieved with the sphincterotome. a moderate diffuse dilation was seen at the biliary tree. there were subtle filling defects suggestive of sludge or stones. no definitive stricture was seen, although there was a very subtle area of irregularity in the lower/mid cbd. contrast opacification was intentionally limited due to clinical suspicion of cholangitis and the cystic duct was not opacified. sludge and pus was extracted successfully using a balloon a 7cm by 10fr biliary stent was placed successfully in the bile duct. sphincterotomy was not performed because of the patient's abnormal inr. otherwise normal ercp to 3rd portion of duodenum. recommendations: juices when awake and alert, then advance diet as tolerated. continue antibiotics. prior imaging (with contrast) needs to be reviewed. there is no definitive evidence of malignant stricture on today's exam. if there is definitive mass, then could consider metal stent placement at next ercp. otherwise, would consider ercp with sphincterotomy for definitive treatment of biliary stones/debris. repeat ercp in 8 weeks. needs inr checked 4 days before, goal <1.5. ongoing discussion with family re: care goals. there is risk of recurrent plastic stent obstruction/cholangitis if repeat ercp is not performed. blood cultures: escherichia coli | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r brief hospital course: -year-old male with history of dementia, cad s/p cabg, recent common bile duct stent () for pancreatitic head mass c/b obstructive jaundice, who presented with fevers, abd pain, nausea and vomiting concerning for ascending cholangitis # ascending cholangitis # e. coli bacteremia patient presented with fever, ruq pain, and elevated bilirubin all suggestive of ascending cholangitis but in addition had some ct features of cholecystitis. he was started on iv zosyn and taken for ercp. ercp revealed sludge and pus in the common bile duct. the old plastic stent was removed and a new plastic one was placed. a metal stent was not placed because of active cholangitis (more risk of bacterial translocation). because plastic stents are only good for short term, he would ordinarily need a repeat ercp in 8 weeks to switch to a metal stent for long term. there is risk of recurrent plastic stent obstruction/cholangitis if repeat ercp is not performed. however, he was previously on hospice due to failure to thrive and pancreatic head mass, so this plan may or may not be relevant his clinical status should be reassessed in the next 1-2 months and if he is still stable, recommend that a repeat ercp be arranged with gi (dr. ). he would need an inr checked 4 days prior to the procedure, with goal <1.5. - radiology reviewed (non-contrast) ct from from osh: notable for 1.2x1.8cm cystic mass in pancreas (best seen in series 2 image 36). patient will need multiphasic ct to fully evaluate the pancreatic mass. formal read to follow. his antibiotics have been switched from zosyn to ceftriaxone, based on e. coli sensitivities. he should complete a total course of 14 days antibiotics, to be completed . he has a picc line in place (placed ). # rll infiltrate with rhoncherous bs- possibly aspiration pna, but at this point his respiratory status is stable with no clinical signs of pna. adequately tx with zosyn, now ceftriaxone. no role for swallow study at this point (goals are primarily comfort/quality of life), aspiration precautions, pt can resume his prior diet #) agitation, delirium/metab encephalopathy in the setting of active infection, hospitalization, and underlying dementia. - treated with frequent reorientation, fall precautions - he did require low dose haldol while in-house for periods of agitation and for procedures. - continued namenda #) coagulopathy - elevated inr, suspect some underlying liver dysfunction, now improved from 2.1 --> 1.5. no signs of bleeding, hgb stable, monitor .. #) hypothyroid: continue synthroid #) type 2 dm, insulin dependent: continue insulin # stage 2 coccyx ulcer - daughter reports this was present on admission. please clean with commerical wound cleanser with each mepilex change (change q3 days). # coronary artery disease, s/p cabg, hx htn, - stable. appears many of these maintenance meds have been trimmed off due to his overall poor prognosis and goals of care # pancreatic mass and overall goals of care - pt has recently been on hospice due to declining status after wife's death several months ago and recnet diagnosis of pancreatic head mass. iv antibiotics and hospital level care are within goals of care for now for reversible new conditions (like cholangitis). hospice can be reinitiated at after iv antibiotics are completed. note: his daughter reports that the pt may have a propensity to pull at lines. if he does pull his picc line out, would recommend a discussion with pt's family to determine best approach to care. overall the focus has been on quality of life and comfort. if his family feels that it would be best in the future not to re-hospitalize and the pt accidentally pulls the picc line out, then could consider a course of oral antibiotics instead. although this is not the recommended course from a purely infectious disease standpoint, it seems a reasonable compromise if his goals of care are consistent with hospice. his e. coli is sensitive to cephalosporins, including 1st generation and 3rd generation. could consider keflex or cefpodoxime in this instance. code: dnr/dni medications on admission: bactrim ss 1 tab daily levemir 10 units sc qhs with insulin sliding scale cipro 250 mg po daily x 7 days mom 30 cc po daily prn constipation levothyroxine 100 mcg po daily namenda 10 mg po bid haldol 1 mg topically q6h and q4h prn visine eye drops discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day) as needed for constipation. 4. memantine 10 mg tablet sig: one (1) tablet po bid (2 times a day). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 7. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 10 days: continue until . 9. insulin glargine 100 unit/ml solution sig: ten (10) units subcutaneous at bedtime. 10. insulin sliding scale please see accompanying humalog sliding scale. discharge disposition: extended care facility: health and rehab center discharge diagnosis: ascending cholangitis e. coli bacteremia delirium, metabolic encephalopathy secondary: type 2 diabetes pancreatic mass coronary artery disease s/p cabg hypertension hypothyroidism discharge condition: condition: stable mental status: alert but disoriented, oriented to self only ambulatory status: ambulates with assistance discharge instructions: you were admitted for a biliary tract infection called cholangitis which required treatment with a procedure (ercp) and antibiotics. you were also found to have e. coli bacteria in your bloodstream and are being treated with antibiotics for this. followup instructions: his clinical status should be reassessed in the next 1-2 months and if he is still stable at that point, recommend that a repeat ercp be arranged with gi (dr. ( for 8 weeks from now. if his status is declining on hospice, then this can be deferred in favor of comfort-focused care. md procedure: endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate aortocoronary bypass status chronic kidney disease, unspecified bacteremia pressure ulcer, lower back do not resuscitate status metabolic encephalopathy cholangitis other specified diseases of pancreas vascular dementia, uncomplicated cerebral atherosclerosis pressure ulcer, stage ii other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to