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: ureteroileal anastomotic strictures, hypotension, a. fib with rvr. major surgical or invasive procedure: removal of neobladder (cystectomy), excision of lymphocele wall, creation of ileal conduit urinary diversion (conversion of chimney to an ileal conduit with a new double barrel ureteral ileal anastomosis), dr. , history of present illness: 69 y.o. male w/ h.o. high grade invasive transitional call carcinoma of the bladder s/p lap cystectomy, neobladder formation , a. fib w/ rvr in the or today for removal of neobladder, creation of ileal conduit urinary diversion. transfer to icu for a. fib with rvr, hypotension. . pt removal of his neobladder with excision of ileal conduit urinary diversion. prior to the surgery he was noted to be hypotensive in the 90s after receiving diltiazem po. during the surgery he was estimated to have a 500cc bld loss. he was noted intra-operatively to go into a. fib with rvr with a rate 100-110s and sbp in the 80s. he received a total of 9l of fluid with minimal response to hypotension. he was also given po diltiazem with no resulting effect. he was thus started on a dilt gtt and transferred to dilt gtt. in addition to fluid he also received 2u prbcs given his pre-op hct was 28. . upon arrival to the floor his vitals were noted to be t 97.4, hr 110, bp 103/50. pt denied any chest pain, chest palpitations, sob, lightheadedness, recent fevers, chills. . on review of his prior hospitalizations it appears his microdata is significant for vre as well as pan sensitive e.coli. during his neobladder construction he was noted to be hypotensive that was thought to be due to sepsis from vre. at that time he was on a regimen of linezolid and zosyn. . review of systems: (+)ve: (-)ve: fever, chills, chest pain, palpitations, dyspnea, nausea, vomiting, diarrhea. past medical history: 1. h/o mi - 17 yrs ago, treated at hospital, per patient treated with a "clot busting medication" (possibly tpa), hospitalized x 6 days and discharged. as noted previously, he did not take medications after discharge and did not follow up with any physicians 2.paroxysmal atrial fibrillation, discovered at time of cancer diagnosis , difficult to control post-operatively . has recurrences of af/rvr during last hospitalization. 3.high-grade invasive transitional cell carcinoma 4.osteoarthritis of ankles 5.c. difficle colitis 6. klebsiella bacteremia (last ) with klebsiella uti 7. gastritis/duodenitis 8.left percutaneous nephrostomy tube for presumed obstructive uropathy. 9.right percutaneous nephrostomy tube, emergent, for obstructed pyelonephritis. 10. vre septic shock s/p neobladder construction () social history: -married and lives with wife in . retired, worked as a construction worker. -smoking: 30+ py, quit before -etoh: denies -drugs: denies family history: -mother died at yrs. -father died in early 70's from asbestosis physical exam: t=97.4. bp=103/50 hr=110 rr=16 o2= 98% . . physical exam general: pleasant, well appearing caucasian male in nad heent: no scleral icterus. eomi. mmm. cardiac: irregularly, irregular, s1, s2, borderline tachy (110s)lungs: ctab, good air movement biaterally. abdomen: rlq ostomy noted with drain in place. b/l quadrants have jp drains. abd dressing c/d/i. extremities: no edema neuro: a&ox3. appropriate. cn 2-12 grossly intact. psych: listens and responds to questions appropriately, pleasant pertinent results: 06:00am blood wbc-6.8 rbc-3.19* hgb-9.0* hct-27.2* mcv-85 mch-28.1 mchc-33.1 rdw-15.8* plt ct-245 05:34pm blood neuts-86.6* lymphs-8.4* monos-3.3 eos-1.4 baso-0.4 06:15am blood pt-19.4* inr(pt)-1.8* 07:40am blood pt-17.8* inr(pt)-1.6* 06:00am blood pt-17.0* inr(pt)-1.5* 07:50am blood glucose-84 urean-7 creat-1.3* na-138 k-4.3 cl-103 hco3-28 angap-11 07:50am blood calcium-8.0* mg-1.9 brief hospital course: icu course (by problem): ##. hypotension: patient was admitted to icu rather than floor post-op due to hypotension. hypotension was thought to be related to a. fib with rvr with rates ranging from 110-120s. pt received a total of 7l ns in the pacu over 7 hours but was still noted to have a bp in the mid 70s, asymptomatic. differential included a. fib with rvr given his prior history, however would expect a more impressive rate to give such hypotension. other differentials to consider included possible sepsis that could have occured peri-op, he was also noted to have leukocytosis prior to his operation. on review of his record he has had septic shock after gu procedures as well as a history of vre, pan sensitive e.coli. pt's bp also noted to decrease after diltiazem 120mg was given. for possible sepsis patient was bolused with 500cc lr to check bp response, pt mentating well currently. changed antiobiotics of vanc and ceftriaxone to zosyn (for broad gram positive, negative coverage) and linezolid (vre coverage). pt received diltiazem and is on morphine pca which could also explain the hypotension. blood cultures were sent. antibiotics were then discontinued on post-op day 2 per urology, given no evidence of infection, and resolution of hypotension. . ##. a. fib with rvr: pt has history of a. fib with rvr post-op following a prior gu surgery performed in . on review of anaesthesia records it appears his a. fib was in the 100-120 range, he received a total of 9l ns as mentioned above as well as 2u packed red blood cells. he received diltiazem 120mg sr with his rate responding 85-103. on review it appeared he required amiodarone 150mg bolus and drip during prior episodes. amiodarone was started on post-op day 1. this was discontinued per cardiology consult, and the patient's rate was subsequently controlled with diltiazem iv boluses, follow by a diltiazem drip. he was on warfarin at home given his atrial fibrillation, despite having a chads2 score of zero, and warfarin was continued during his hospital course. the diltiazem drip was discontinued and transitioned to oral. initial dose was diltiazem 90 mg po qid, increased to 120 mg qid for rate control. bradycardia to 40s followed first 120 mg dose, and patient was converted back to diltiazem 90 mg po qid. adequate rate control was achieved with this dose, and the patient was subsequently transferred out of the icu. . ##. s/p ileal conduit urinary diversion: pt ileal conduit urinary diversion in addition to neobladder. urology currently following pt, who is npo per their recommendations. patient remained npo on post-op day 2, with slow transition to clears on pod 4. ileus remained. . ##. leukocytosis: pt noted to have leukocytosis of 16.4 on admission. unclear as to the etiology, pt does have h.o. of vre colonization within his gu system, multiple infections. no fevers reported. leukocyte count trended down. . ##. renal insufficiency: pt currently sees a nephrologist in for his insufficiency. prior to admission baseline creatinine has ranged from 1.9-2.0. prior creatinine level of was thought to be due to atn from hypovolemia. renal insufficiency is thought to be obstruction from transitional bladder cell cancer with obstruction. creatinine was improved from baseline on pod #2. . ##. hyperchloremic acidosis: likely related to large volume resuscitation from ns. trended during course . ##. fen: keep npo for now per urology. replete lytes prn . ##. ppx: dvt ppx with pneumoboots, pain management with morphine pca. . ##. access: 2 piv's . ##. code status: full code confirmed . ##. emergency contact: (wife and hcp) . ##. disposition: pending resolution of symptoms. floor hospital course: mr. conversion of ileal neobladder to an ileal conduit on and was transferred to the (as detailed above) for close monitoring due to afib and hypotension. no concerning intraoperative events occurred; please see dictated operative note for details. once his acute cardiac issues stabilized, he was deemed stable for transfer out of the to dr. urology service. patient received perioperative antibiotic prophylaxis and deep vein thrombosis prophylaxis with . his inr was noted to be supratherapeutic after two doses of and subsequent doses were held until his inr dropped in the therapeutic range. with the passage of flatus, patient's diet was advanced. the patient was ambulating and pain was controlled on oral medications by this time. physical therapy worked with the patient and cleared him for discharge home once stable from a medical standpoint. the ostomy nurse saw the patient for ostomy teaching. at the time of discharge the wound was healing well with no evidence of erythema, swelling, or purulent drainage. the ostomy was perfused and patent. patient is scheduled to follow up in one week's time in clinic for wound check. additionally his pcp's office was regarding mr. discharge dosages of and diltiazem. dr. nurse has arranged follow up in 2 days. medications on admission: metoprolol 25mg xl daily diltiazem sr 120mg daily mvi 1tab daily colace 100mg daily warfarin 3mg daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. tylenol-codeine #3 300-30 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. disp:*40 tablet(s)* refills:*0* 3. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* 4. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: bladder cancer discharge condition: stable discharge instructions: -please resume all home meds -tylenol should be your first line pain medication, a narcotic pain medication has been prescribed for breakthough pain >4. replace tylenol with narcotic pain medication. max daily tylenol dose is 4gm, note that narcotic pain medication also contains tylenol (acetaminophen). -do not drive while taking narcotic pain medication -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops -you may shower, but do not immerse incision, no tub baths/swimming -small white steri-strips bandages will fall off in days, you may remove at that time if irritating, if staples are present they will be removed by dr. at a follow up appointment in days --if you have fevers > 101.5 f, vomiting, or increased redness, swelling, or discharge from your incision, call your doctor or go to the nearest er -please refer to visiting nurses (vna) for management of the ileal conduit. -please make an appointment to see your cardiologist, pcp, whoever manages your and blood pressure/heart medications within the next 2 days. followup instructions: please contact dr. office upon discharge to arrange follow up appointment. please contact your pcp . upon discharge to arrange for management of your inr, dosage and hypertension medications. procedure: ureteral catheterization other operations on lymphatic structures revision of ureterointestinal anastomosis diagnoses: acidosis other iatrogenic hypotension atrial fibrillation urinary complications, not elsewhere classified personal history of malignant neoplasm of kidney other noninfectious disorders of lymphatic channels 

Answer: The patient is high likely exposed to