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: macrodantin / zosyn attending: chief complaint: fever major surgical or invasive procedure: picc line placement foley catheter right internal jugular venous bronchoscopy history of present illness: 62 yo woman with ms (non-verbal), chronic vent transferred from rehab () with potassium of 7.2. she was given kayexelate and calcium gluconate 2 amps then transferred here. potassium here 3.9. she was found to be febrile to 101.2. of note she had a midline placed yesterday. per her daughters this was to treat a urinary tract infection, which she gets frequently. at baseline her daughters report she interacts with them by nodding yes or no. she does this about 80% of the time when she is at her best. .ros: per her daughters she has been more drowsy the past few days, and may have had fever yesterday. they deny any diarrhea, change in vent secretions, known change in sacral decubs, or recent epidemics at her facility. she was noted to be in a room with a patient colonized with vre so had to be moved. . review of reocrds from hospital: urine cx : proteus sensitive to amikacin, aztreonam, ceftaz, cefepime, cefoxitin, cefuroxime, cefotetan, imipenem, zosyn; pseudomonas sensitive to amikacin, ceftaz, cefepime, defotetan, imipenem, zosyn. urine cx : proteus, same sensitvity panel except resistance to aztreonam. respiratory culture : gnr's: pseudomonas, 2 other colonies, gpr's. wbc 10.3 , 76% pmn's, potassium 7.2 (not hemolyzed) md orders: : cefuroxime 500mg x14 days, : cefuroxime d/c'd, bactrim ds started notes: desat to 70's , suctioned, switched from simv to ac, fio2 increased, sats to 98. . in the ed, vs: t on arrival: 101.2 t at transfer: 99.8 hr 78 bp 129/74 rr 15 sat 100% on ac 500/15/5/35%. she was given vancomycin 1gm iv, cefepime 2gm iv, tylenol and 1l ns. blood cultures and urine culture were sent. past medical history: nephrolithiasis: staghorn calculi, urosepsis, stent placement ms: vent dependent x7 years, s/p g-tube chronic decubitus ulcers copd hypertension anemia gallstones dm social history: in nh/rehab for many years. no history of smoking or etoh use. family history: mother with breast ca, sister with ovarian ca, multiple family members with dm, htn, cva. physical exam: vs: t: 98 hr: 78 bp: 101/57 rr: 19 sat: 97% on 500/10(13)/5/35% gen: elderly woman in nad heent: nc/at, sclera white, conjunctiva pink, disconjugate gaze (baseline per daughter), 3->2mm, unable to assess op neck: no lad, unable to assess jvp 2/2 habiuts cv: rrr, s1, s2 present, no murmurs/rubs/gallops, 2+ dp pulses bilaterally resp: bilat rhochi r>l, no wheezes, rales, rhonchi abdomen: soft, nt, nd, +bs, no masses or organomegally, g-tube site intact, midline lower abdominal scar, well-healed (thought c-section) ext: trace edema ue/le bilaterally, chronic contractures neuro: moves head, eyelids, does not respond to commands, no movement of torso/extremities skin: sacral decubitus ulcer and left hip ulcer: sacral probes beyond view, hip probes to friable, necrotic looking tissue, unclear if either go to bone, no other rashes pertinent results: admission labs: 02:40pm wbc-9.2 rbc-3.79* hgb-10.3* hct-30.5* mcv-81* mch-27.1 mchc-33.7 rdw-15.5 02:40pm neuts-80.9* lymphs-12.2* monos-5.9 eos-0.6 basos-0.5 02:40pm plt count-324 02:40pm pt-13.6* ptt-33.5 inr(pt)-1.2* 02:40pm alt(sgpt)-39 ast(sgot)-29 alk phos-109 amylase-65 02:40pm glucose-114* urea n-26* creat-0.6 sodium-139 potassium-3.9 chloride-104 total co2-22 anion gap-17 03:30pm urine 3phosphat-rare 03:30pm urine rbc-21-50* wbc-21-50* bacteria-mod yeast-none epi-0 03:30pm urine blood-lg nitrite-pos protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-mod 04:10pm lactate-2.8* cxr - in comparison with the study of , the right ij catheter has been removed and replaced with a right subclavian line that extends to the lowest portion of the superior vena cava. again, the cardiac silhouette is displaced to the right. some increased opacification at the right base is consistent with partial collapse. tracheostomy tube remains in place . renal us - - multiple renal stones bilaterally. no evidence of gross hydronephrosis. bladder is poorly visualized. . 3:30 pm urine clean catch. **final report ** urine culture (final ): proteus mirabilis. presumptive identification. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 16 i cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 4 s meropenem-------------<=0.25 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . 5:36 pm bronchoalveolar lavage site: endotracheal **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. gram negative rod(s). 10,000-100,000 organisms/ml.. of two colonial morphologies. gram negative rod #3. 10,000-100,000 organisms/ml.. pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. 2nd strain. pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. gram negative rod(s). ~6ooo/ml. 6th type. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. gram negative rod(s). ~3000/ml. 7th type. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | pseudomonas aeruginosa | | cefepime-------------- 4 s <=1 s ceftazidime----------- 4 s <=1 s ciprofloxacin--------- 2 i =>4 r gentamicin------------ <=1 s <=1 s imipenem-------------- <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- 8 s <=4 s piperacillin/tazo----- 8 s <=4 s tobramycin------------ <=1 s <=1 s brief hospital course: 62 yo woman with ms who presented from rehab with hyperkalemia, now with fever, elevated lactate. . # fever: multiple possible sources, given elevated lactate concerning for sepsis though bp relatively stable, not tachycardic, normal wbc. urine culture from osh positive for proteus and serratia, cefepime sensitive uti although the patient has a chronic indwelling foley difficult so this could be colonization. cxr significant for rrl collapse, likely complicated by a pna. underwent bronchoscopy on and had thick secretions suctioned. the following day her cxr showed mild improvement, with better visualization of her right heart border. sputum from osh positive for pseudomonas with sensitivies pending. plastics saw her decubs, felt that they were chronic and not contributing to her fevers. has staghorn calculi bilaterally by kub - urology consulted and did not feel that these were contributing to her acute picture and could be followed as an outpatient. the patient was placed on cefepime and will continue a 15 day course. . # hyperkalemia/hypokalemia: unclear etiology, after treatment with kayexelate improved to 3.9. she then became hypokalemic the following day, requiring potassium supplementation. cr was in normal range but may be elevated for her given chronic immobility. consider obstructing stone with hydronephrosis vs. hemolysis. no concerning changes on ecg. urology was consulted for lithotripsy - did not recommend inpatient procedure, outpatient appointment scheduled for with dr. at . . # sacral decubitus and left hip ulcers: plastics feels they are chronic as above no acute intervention was felt to be warranted. the patient was given a kinair bedand wound care reccomendations were followed. . # staghorn calculi: likely infected (proteus). she was continued on cefepime. proteus not sensitive to cipro per osh cultures. urology consult reccommended no intervention at this time. she has an outpatient appointment scheduled for with dr. at . . # chronic respiratory failure: she remained stable and wa maintained on her current vent settings. . # hypertension: on metoprolol, captopril at baseline. unknown if she has autonomic dysregulation with ms. were held and restarted at discharge. . # copd: her atrovent/albuterol was continued. . # anemia: unknown baseline hct, microcytic. continued iron supplementation and monitored for acute blood loss. . # dm: continued home regimen of lantus and ssri, monitored bg, well-controlled on current regimen . # fen: tube feeds per nutrition consult. monitored and repleted lytes prn. medications on admission: milk of magnesia 30ml q4 prn dulcolax pr daily vitamin c 500mg po bid tylenol 650mg po q4 prn zinc 220mg po daily theragram daily metoprolol 50mg atrovent neb q6hr prn novolin slikding scale q12 lantus 22u qhs feosol 325mg po bid nexium 40mg po daily vitamin d 400u qd lovenox 40mg daily colace liquid 100mg captopril 12.5mg q8 combivent 4 puffs qid albuterol q6h prn discharge disposition: extended care facility: hospital discharge diagnosis: hyperkalemia urinary tract infection pneumonia discharge condition: improved discharge instructions: you were admitted for hyperkalemia. you were treated for this electrolyte disorder and your levels of potassium are now low normal. you have a fever and cultures from you urine and lungs showed evidence of infections for which you have been prescribed a course of antibiotics. if you should experience any return of your fevers, increased difficulty breathing, hypotension or any symptoms that are new, worse or of concern to you or your care provider please call your physician or return to the hospital. followup instructions: dr. , urology, , at 10am. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: hyperpotassemia anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified pulmonary collapse pressure ulcer, lower back multiple sclerosis other and unspecified complications of medical care, not elsewhere classified calculus of kidney gastrostomy status chronic respiratory failure tracheostomy status dependence on respirator, status pressure ulcer, hip 

Answer: The patient is high likely exposed to