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 / ambien / trazodone attending: chief complaint: fever and altered mental status major surgical or invasive procedure: transesophageal echocardiogram on . impression: pacing wires present with shaggy echodensities that could represent presence of clot / fibrin / vegetations. no valvular vegetations seen. severely depressed left ventricular function. moderate mitral regurgitation. picc placement history of present illness: 73 year old male with cad, chf (ef 20%), v-tach s/p icd placement, afib on warfarin, s/p whipple, chronic dyspnea with 2.5l nc at baseline, presenting with fever (100.2 at home), rigors, and altered mental status. patient has a history of aspiration pneumonia, with admission in requiring an icu stay and ventilation. patient relates that symptoms began yesterday with fevers, shaking chills and overall malaise. he did have a cough prior to admission, which was not productive of sputum, but usually brought up undigested food. due to constipation, the patient took extra colace and senna yesterday, and he had bowel movements. after straining during one bowel movement, he felt short of breath and dizzy. he denies having any chest pain yesterday, although history in the ed had noted some chest pain prior to admission. at his baseline, the patient sometimes has dyspnea on exertion (walking around his home) and sleeps on 2 pillows at night. he denies any leg swelling. he denies any nausea, vomiting, abdominal pain, diarrhea, hematochezia, melena, dysuria or hematuria. in the ed, initial vs were: 99.2 74 95/64 16 99%. he was alert and oriented x2, pale, diaphoretic, and hypotensive to sbp 75. of note, from recent previous omr records, baseline bp is 105/68. rij placed, with cvp 13 and map ~60. after <500 cc of fluids and abx, pt with improved ms though still not oriented to time. vanc + levoflox given. cxr showed bilateral opacities c/w atelectasis vs. infection. total ivf given ~750cc with resolving pressures to bp 91/51. given no meningismus, ha, or neck pain, lp was deferred. vitals on transfer: 101.8, 75, 91/51, 17, 97% 2l nc and cvp 13. in the icu, the patient was comfortable, oriented x3 and conversant. he knew that he was in the icu, but not in the "nice" icu that is in the clinical center. he was breathing comfortably on supplemental oxygen by nasal cannula. he was able to provide details of his history. past medical history: 1. coronary artery disease - status post anterior wall myocardialinfarction in - mi c/b large apical aneurysm and vt/vf s/p ablation - s/p biventricular pacer implantation (replaced previous dual chamber icd) for complete heart block - pacemaker interrogated 2. systolic heart failure - ejection fraction 20% on tte in 3. atrial fibrillation, status post cardioversion , on anticoagulation, managed by dr. office. 4. hypertension. 5. hypothyroidism. 6. anemia. 7. irritable bowel syndrome. 8. constipation. 9. obesity. 10. hearing loss, requiring bilateral hearing aids. 11. squamous cell carcinoma of the left lower eyelid . 12. vitamin d deficiency. 13. cerebral infarction . 14. gait disorder with history of falls. 15. compression fractures. 16. bile duct dysplasia s/p ercp/stent/sphincterotomy and whipple operation c/b e. coli and klebsiella bacteremia (at ). apparently, the source of the bacteremia was his teeth. he is s/p removal of all of his teeth. 17. abdominal hernia secondary to a local procedure. 18. syncope. 19. hemorrhoids. 20. vre infection past surgical history (per omr): 1. replacement of pacemaker and icd implantation with revisions. 2. knee surgery. 3. squamous cell removal of the left lower eyelid. 4. whipple procedure. 5. right eye cataract surgery social history: the patient lives with his significant other, . he is divorced, and has two grown daughters. taught british and american history at and . - tobacco: previous smoker. began smoking cigarettes in high school and continued until age 60. also, smoked a pipe until age 60. - alcohol: glasses of wine per day. - illicits: none ever. family history: father died of stroke age 59. mother died of mi at age 70. brother with mi in his 50s, deceased. second brother deceased with pancreatic cancer. physical exam: admission physical exam: vitals: t: 99.2 (37.3) bp: 92/56 p: 75 rr: 16 spo2: 96% nc general: alert, oriented x3, conversant, no acute distress heent: sclera anicteric, mmm, oropharynx clear, adentulous neck: supple, jvp not appreciated, no lad lungs: crackles at the bases bilaterally, no wheezes cv: paced, regular rate and rhythm. holosystolic murmur, loudest at llsb with radiation to the apex. no carotid bruits. abdomen: soft, non-tender, non-distended, bowel sounds present, small midline ventral hernia. gu: + foley ext: warm, well-perfused, 2+ pulses, fingernails mostly white with thin reddish line at tip (c/ nails), no edema discharge physical exam: vs: t 100.8 hr 75 bp 93/49 rr 21 95%/2l o2xnc gen: nad, comfortable, scab/thickened skin on forehead cardiac: rrr, holosystolic murmur loudest at llsb abd: soft, nt, pos bs, ventral hernia, very mildly distended abdomen ext: warm, perfused pertinent results: 05:50pm wbc-8.5# rbc-3.36* hgb-11.5* hct-33.5* mcv-100* mch-34.3* mchc-34.4 rdw-15.1 05:50pm neuts-90.8* lymphs-5.2* monos-2.0 eos-1.6 basos-0.5 05:50pm glucose-114* urea n-34* creat-1.3* sodium-133 potassium-5.2* chloride-98 total co2-24 anion gap-16 10:51pm pt-29.9* ptt-34.0 inr(pt)-2.9* 05:50pm ctropnt-<0.01 probnp-3062* 06:07pm lactate-1.6 06:10pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg micro: mrs pending bcx x2 pending ucx pending imaging: cxr : left-sided pacemaker device is noted with leads terminating in the right atrium, right ventricle, and coronary sinus. abandoned leads are also noted. there are low lung volumes. the heart size is moderately enlarged. the aortic knob is calcified, and there is mild tortuosity of the thoracic aorta. there is mild pulmonary vascular congestion. no focal consolidation, pleural effusion or pneumothorax is present. streaky opacities in the lung bases may reflect atelectasis, though infection is not excluded. there are no acute osseous abnormalities. impression: mild pulmonary vascular congestion. low lung volumes with streaky opacities in the lung bases, possibly atelectasis, although infection is not excluded. repeat films with improved inspiration may be helpful for further evaluation. 6:05 pm blood culture (2 bottles) blood culture, routine (preliminary): gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). reported to and read back by 12:12pm. anaerobic bottle gram stain (final ): gram negative rod(s). tee: pacing wires present with shaggy echodensities that could represent presence of clot / fibrin / vegetations. no valvular vegetations seen. severely depressed left ventricular function. moderate mitral regurgitation. compared with the prior study (images reviewed) of , there appears to be more material associated with the wires, although less views of the wires were taken previously. brief hospital course: 73 m with extensive cardiovascular history including chf secondary to ischemic cardiomyopathy with ef 20%, implanted biventricular pacer and atrial fibrillation on warfarin, as well as recent hospital admission for aspiration pneumonia, who was admitted to the hospital for aspiration pneumonitis and klebsiella oxytoca bacteremia. pt was initialy admitted to the icu and then transfered to the medical floor. active diagnoses: # gnr bacteremia/hypotension. pt initial febrile, hypotensive (low 80s) and found to have klebsiella oxytoca bacteremia. unclear source of infection as ct abd and pelvis unrevealing for gi source and urine neg for source. tee showed no signs of endocarditis but there were ?fibrinous material on the leads suspicious for fibrin clot versus vegetations. he was intialy given vanco/levoflox/flagyl for empiric coverage and then transitioned to cefepime for a few days followed by ceftriaxone. he will go home with 2 weeks of ceftriaxone (though ) followed by cefpodaxime 200mg po therafter. bp remained primarily in the 90-110 range. #aspiration pneumonitis. patient's history of difficulty swallowing and presentation with fever, hypotension, clear cxr, and quick resolution of elevated wbc was suggestive of aspiration pneumonitis rather than aspiration pna. maintained on regular diet with thickened liquids and aspiration precautions. # systolic chf: baseline low ef with evidence of pulmonary congestion in cxr, although exam not consistent with volume overload. continued home furosemide, beta blocker, and asa. held lisinopril given acute kidney injury. repeat tte showed ef 15-20 %. severely hypokinetic,dilated right ventricle. apical left ventricular aneurysm without clot seen. moderate pulmonary artery systolic hypertension. similar to that on 12/. # ams: cleared quickly. thought to be secondary to cerebral hypoperfusion due to baseline decreased systolic function that was exacerbated by sirs from infection. pt a+o x3 at time of discharge. # : creatinine peaked to 1.3 (from baseline 1.1), with bun 34. likely prerenal azotemia from baseline poor systolic function, with decreased preload secondary to sirs, and cardiac inability to increase stroke volume. cr improved with some gentle ivf. his cr at baseline was 0.8-1.0. # anemia: macrocytic, chronic. stable at discharge hct (29). #a fib: pt with paroxysmal a fib years ago. he was last in a fib 2 yrs ago. he was continued on coumadin with goal inr . inr at discharge was 2.5. pending: -blood cx from , , , , transitional issues: - has recurrent gram neg rod bacteremia. unclear primary source. possibly gi although ct abd and pevlis unremarkable. he will follow up with his gi doctors. - tee showed some thick fibrinous material on the leads. unclear if this is infected. will be treated for 2 weeks iv antibiotics followed by po antibiotics. - recurrent aspiration events. s&s saw pt in house and made reccomendations: 1. po diet: thin liquids, soft solids. 2. small pills whole, large pills crushed with puree. 3. take small sips of liquid. 4. alternate bites and sips. 5. oral care. 6. assistance with meals as needed. - mrsa positive in nares -tee: pacing wires present with shaggy echodensities that could represent presence of clot / fibrin / vegetations. no valvular vegetations seen. severely depressed left ventricular function. moderate mitral regurgitation. medications on admission: amiodarone 200 mg daily bupropion hcl 150 mg daily furosemide 60 mg daily levothyroxine 100 mcg tablet daily\ lipase-protease-amylase - unknown dose lisinopril 2.5 mg daily metoprolol tartrate 12.5mg oxygen 2.5l via nasal cannula daily upon exertion pramipexole 0.125 mg qhs prn restless legs ranitidine hcl 75 mg warfarin 1-4 mg daily aspirin 81mg daily cholecalciferol (vitamin d3) 1,000 unit daily docusate sodium 100 mg capsule tid prn ferrous sulfate 325 mg (65 mg iron) daily (mwf) guar gum packet daily sennosides 8.6 mg prn discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po daily (daily). 3. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: one (1) cap po tid w/meals (3 times a day with meals). 6. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. pramipexole 0.125 mg tablet sig: one (1) tablet po qhs prn () as needed for restless leg syndrome. 9. ranitidine hcl 150 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. warfarin 2 mg tablet sig: one (1) tablet po 6x/week (,mo,tu,we,th,sa). 11. warfarin 2 mg tablet sig: two (2) tablet po 1x/week (fr). 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 17. ceftriaxone 2 gram recon soln sig: one (1) intravenous once a day for 20 days: take through . disp:*20 days* refills:*0* 18. oxygen 2.5l nc sig: as directed as directed: uses 2- 2.5l nc at all times. 19. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day: *start: . continue until infectious disease doctor says. 20. lab draw sig: one (1) once a week: cbc with diff, chem 7, inr/ptt, lfts. fax results to: attn dr. . 21. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 22. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. discharge disposition: extended care facility: newbridge on the - discharge diagnosis: gram negative rod bacteremia congstive heart failure discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you at ! you were admitted with a fever and confusion. you were found to have gram negative rod bacteria in your blood culture, and you were treated with antibiotics. you were found by laboratory testing and physical exam not to have other causes of fever such as pneumonia, meningitis, encephalitis, colitis, gastroenteritis, or pulmonary embolism. your mental status improved throughout hospitalization. we will send you home on ceftriaxone, an iv antibiotic for 2 weeks. the last day of your iv antibiotics will be . you have an appointment with dr. scheduled for at 1pm. dr. will be able to further direct your management. medication changes: start: ceftriaxone 2gm iv continue taking your regular medications as prescribed weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please follow-up this hospitalization with the following appointments: please make sure you arrange an appointment with your gi doctor from in the next 2 weeks. department: gerontology when: thursday at 11:30 am with: , md building: lm campus: west best parking: garage department: medical specialties when: wednesday at 10:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: infectious disease when: wednesday at 1 pm with: , md building: lm campus: west best parking: garage department: dermatology and laser when: monday at 1:15 pm with: ,katheen building: (, ma) campus: off campus best parking: free parking on site\ndepartment: cardiac services when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart central venous catheter placement with guidance diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation other chronic pulmonary heart diseases other convulsions abnormality of gait other specified forms of chronic ischemic heart disease constipation, unspecified bacteremia unspecified hearing loss old myocardial infarction chronic systolic heart failure long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits other postprocedural status altered mental status obesity, unspecified unspecified vitamin d deficiency irritable bowel syndrome other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms history of fall systemic inflammatory response syndrome, unspecified 

Answer: The patient is high likely exposed to