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: hypernatremia major surgical or invasive procedure: picc line placement history of present illness: mrs. is an 83 yo female with dementia and b12 deficiency who presented to her pcp's office today for an epi visit with her son who described the patient as having worsening mental status and increased lethargy for the past 1.5 weeks, being difficult to arouse and eating and drinking less. her son also reported a nonhealing sacral decubitus ulcer that keeps opening and draining; has been followed by vna as outpatient. the patient is nonverbal at baseline, but normally eats when prompted to do so. son does not think she's had a fever, no obvious changes in bowel or bladder pattern (is incontinenet of urine, has to have bowel clean out with weekly). vital signs at pcp's office were: rectal temp 98.7 bp faint at 84/54 (verified systolic by palp)rr 12. concern existed at that time for sepsis, and the pcp recommended evaluation and admit. . in the ed, initial vs were: t96.6 84 106/69 16 96% on ?4l nc. labs drawn were notable for a sodium of 169, chloride of 130 and bun/cr of 29/1.2 (bl 17/1.0). patient was given 2l ns and started on 1/2ns. initially to be admitted to floor but was thought to require too much nursing care and changed to micu admission. . on the floor, patient very lethargic, responds to voice but nonverbal, inconsistently following simple commands. . review of sytems: (+) per hpi (-) unable to obtain currently. past medical history: alzheimer's dementia b12 deficiency anemia depression sacral decubitus ulcers h/o urinary incontinence social history: lives at home with 24 hr care and vna for decubitus ulcer care. son, , who is hcp is nearby and very attentive to patient. family history: unable to obtain physical exam: gen: thin, cachectic appearing elderly female, difficult to arouse, follows some commands, but not able to cooperate with majority of exam. heent: per ed: pupils unequal, left pinpoint, with lid lag, right 4mm and nonreactive, but cataract overlying. here: r minimal reactive and sluggish (3.5->3), unable to visualize l pupil due to patient resistance (also resists opening of r eye). neck: flat jugular veins. cor: rrr, soft sm at lusb. lung: unable to cooperate with exam, generally quite decreased with rhonchi at rll abd: soft, patient winces to palpation diffusely, no masses appreciated, no r/g. rectal/back: 2-3 cm stage 2 decubitus sacral ulcer, does not appear infected, clean base. duoderm dressing in place. neuro: able to open eyes with prompting, squeezes hand lightly to verbal command, does not follow command to move toes/les. pertinent results: cxr : impression: 1. no focal consolidation. 2. dilated loops of bowel. 3. possible chronic interstitial lung disease. kub : pending 05:55pm blood wbc-8.8 rbc-4.69 hgb-14.3 hct-43.5 mcv-93 mch-30.4 mchc-32.8 rdw-15.1 plt ct-132* 04:15am blood wbc-9.8 rbc-4.05* hgb-12.4 hct-38.5 mcv-95 mch-30.6 mchc-32.1 rdw-14.8 plt ct-119* 05:55pm blood neuts-86.6* lymphs-10.5* monos-2.2 eos-0.6 baso-0.2 04:15am blood neuts-87.7* lymphs-8.3* monos-2.5 eos-1.4 baso-0.1 05:55pm blood pt-12.2 ptt-24.9 inr(pt)-1.0 05:55pm blood glucose-130* urean-29* creat-1.2* na-169* k-3.9 cl-130* hco3-30 angap-13 08:40pm blood glucose-107* urean-27* creat-1.0 na-169* k-3.5 cl-131* hco3-29 angap-13 04:15am blood glucose-99 urean-20 creat-0.8 na-159* k-3.3 cl-126* hco3-25 angap-11 09:00pm blood ck(cpk)-216* 09:00pm blood ck-mb-5 ctropnt-0.11* 05:55pm blood calcium-9.7 phos-2.7 mg-2.9* 04:15am blood albumin-3.0* calcium-7.9* phos-2.2* mg-2.1 04:15am blood tsh-1.4 05:53pm blood glucose-126* lactate-2.6* na-171* k-4.0 cl-120* calhco3-28 07:01am blood wbc-9.4 rbc-3.20* hgb-9.7* hct-28.2* mcv-88 mch-30.3 mchc-34.4 rdw-15.0 plt ct-202 07:01am blood plt ct-202 07:01am blood glucose-67* urean-13 creat-0.7 na-138 k-3.6 cl-107 hco3-27 angap-8 05:41am blood tsh-1.9 . .. . urine add on @1446 chem# d. **final report ** urine culture (final ): klebsiella oxytoca. >100,000 organisms/ml.. klebsiella oxytoca. 10,000-100,000 organisms/ml.. second morphology. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella oxytoca | klebsiella oxytoca | | ampicillin/sulbactam-- 4 s 4 s cefazolin------------- 8 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- <=16 s <=16 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r =>16 r . . . cxr final report ap chest, 7:33 p.m., history: dementia and fever. impression: ap chest compared to and 4: peripheral opacity at the base of the right lung has increased in size in radiodensity over the past three days. this has been ascribed to surgery in the breast, but could be a small mass or infection in the lung and warrants conventional radiographs including obliques when feasible. lungs are otherwise clear, mildly hyperinflated. heart is mildly enlarged, but there is no pulmonary vascular engorgement, edema or effusion. in the upper abdomen, the colon is moderately distended. left pic catheter ends in the mid-to-upper svc and a nasogastric tube ends in the upper stomach. the study and the report were reviewed by the staff radiologist. dr. li dr. approved: mon 12:55 pm . . brief hospital course: --- pt could not leave earlier as she had to complete her antibiotic course. -- 83f with dementia and b12 deficiency anemia who presented with worsening functioning, decreased po intake, now admitted with hypernatremia which is resolving. . # dementia: appears to be subacute on chronic due to alzheier's/b12. unclear etiology. head ct shows slight increase in ventriculomegaly from which can be seen in nph. spoke with neuro who feels that nph is unlikely given her ambulation cannot be assessed. also notes that clinical resolution of hypernatremia can trail lab resolution by weeks to months. may also be due to uti. tsh, b12, folate wnl. pt did not pass s+s, had palliative care involved with family mtg where it was determined that the pt would be . ng tube and meds d/c'd, she is to have po diet (thin liquids) as she wishes for comfort. she was sent home with hospice with morphine and tylenol for comfort. . # low grade temps: patient p/w with worsened mental status, poor po intake, rectal temp 98.7, and initial hypotension. has sacral decub. initially oncerning for infectious process. no signs of sepsis or hypothermia since admission. ucx with >100k gnrs, klebsiella, cipro sensitive, which she completed treatment for. the pt also subsequently developed a rll/rml infiltrate concern for aspiration from her tube feeds. she received levo/flagyl for 4 days, however, pt was made so we d/c'd ng tube and meds. . #. dilated loops of bowel: at baseline, per , pt only has approx one bm per week with laxative use. could be due to chronic constipation, but wished to rule out obstruction, ileus, or pseudo-obstruction. kub no e/o obstruction. had good relief with colace, senna, bisacodyl and soap suds enema. now d/c'd for comfort measures and pt not eating much. . # hypernatremia: na 169 initially, 149 on xfer. given dementia and low baseline functional status, likely secondary to impaired access to free water, but also another contributing etiology such as infection/sepsis, impaired po intake from bowel obstruction or pseudoobstruction, mi must be considered. no medications other than b12 to explain increase in serum na, also son does not report recent diarrhea, polyuria, or fever to suggest extra-renal losses or di. calculated free h20 deficit estimated at 4.70l based on 100 kg (likely less than this). uosm not consistent with di. corrected hypovolemia with ns 1l bolus. sodium improved to normal range after receiving 75 cc/hr of d5w (total amt ivfinfused: ~4l). . # decubitus ulcer. stage ii, no evidence of superinfection initially. recent concern for prurulent drainage. can image with mri if concern for early osteo. wound care rn followed and was not concerned for infx. . # anemia: has h/o b12 def. hct stable at 43.5. last vit b12 and folate levels normal on at 850 and 7.2. last injection on , per . b12 levels 1800 this admission. gave monthly b12 dose. fe studies c/w anemia of chr disease. . # hyperglycemia: noted to have blood glucose greater than 500s after d5 1/2ns during this admission. pt does not have apparent h/o dm appears to be new onset dm. riss d/c'd now that pt is . . # pulmonary nodules: seen in rll of lung on kub (not seen on chest films); will not pursue as pt is now . . # arf. likely hypovolemia/prerenal. resolved after volume resuscitation. . fen: po diet with thin liqs as tolerated for comfort . prophylaxis: none now that pt is . access: none now that pt is . . code: dnr/dni // . communication: son and hcp, , cell: medications on admission: cyanocobalamin 1,000 im monthly discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 1-20 mg po q1h as needed for pain or respiratory distress. disp:*90 ml* refills:*0* 2. acetaminophen 160 mg/5 ml solution sig: four (4) po q6h (every 6 hours) as needed for pain or comfort. discharge disposition: home with service facility: hospice of the good discharge diagnosis: primary: end stage dementia (alzheimer's and b12 related) hypernatremia uti aspiration pneumonia due to tube feeds acute renal failure . secondary: chronic sacral decubitus ulcer constipation discharge condition: mental status: confused - always level of consciousness: lethargic but arousable activity status: bedbound discharge instructions: you were admitted due to a high sodium level and urinary tract infection. you were treated with both effectively; however, your mental status and alertness did not improve. you were started on tube feeds temporarily; however, given that you did not improve there was concern that the tube feeds would not provide you with ultimate comfort and benefit as you already had developed a likely aspiration event (pneumonia). it was ultimately determined that you would be made comfort measures only and sent home with hospice. we discontinued your iv lines and feeding tube. please eat and take medications that will optimize your comfort. . please take all medications as prescribed. please do not hesitate to return to the hospital for any concerning symtoms at all. followup instructions: provider: , m.d. date/time: 12:10 provider: , : date/time: 11:40 provider: , m.d. date/time: 11:30 procedure: venous catheterization, not elsewhere classified insertion of other (naso-)gastric tube diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere constipation, unspecified pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back other vitamin b12 deficiency anemia alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia pressure ulcer, stage ii 

Answer: The patient is high likely exposed to