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: fever major surgical or invasive procedure: none history of present illness: 39 year old female multiple medical problems including type 1 diabetes, peripheral vascular disease s/p bka with multiple revisions (most recently ) and wound infections, esbl klebsiella urosepsis, c.diffile colitis presents with fever. she was recently admitted (discharged yesterday) for acute renal failure, hyperkalemia and uti. urine culture was growing > 100,000 citrobacter freundii and she was started on ciprofloxacin with plan for 14 day course. she was seen by vna today, noted to be febrile but without other symptoms. she was sent to ed by pcp. . in the ed, initial vs were: 102.1 90 100/60 14 100. labs notable for cbc of 13.5, lactate 1.5. potassium of 5.8, ekg unchanged. blood and urine cultures drawn. plan to admit to floor but became hypotensive with systolics to the 60s-70s. left subclavian line placed, also w/ piv. given 3l fluid and getting 4th. ua moderately positive. she was evaluated by surgery who felt that stump not likely source of infection. cxr unremarkable. urine and blood culture sent. she was given vancomycin, meropenem. she was given insulin, dextrose and kayexcelate (put out large volume stool). she was upset that being admitted so given ativan 1mg iv. vitals on transfer: 84/45 11 100%. . on the floor, patient has chills but no other complaints. past medical history: - dm type 1 (last a1c=12% in ) - pvd s/p bilateral bkas - systolic chf (ef=40% in ) - nstemi in (in the setting of dka, peak tnt of 1.02) - winter - admission to for pea and mrsa empyema in left lower lobe - depression - chronic anemia - dyslipidemia, hypertriglyceridemia - h/o retinal detachment in os - h/o ards secondary to sepsis - urine has been positive for cocaine on 4 separate occasions in , and twice in . past surgical history: 7/08 l bka r sfa-pt vein bp r bka r bka revision social history: lives in apartment with 16-year-old daughter. denies etoh use currently although reports occasional use in past. cigarettes a day on and off for 10 years. reports marijuana and cocaine, reportedly last use 2 year ago (last positive in 3/). denies any iv drug use. utox on admission positive for opiate (on as rx). family history: father with type 2 dm. physical exam: admission pe: vitals: cvp 3 123/72 69 18 100%2l nc general: african american female in nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp at clavicle, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: s1, s2 regular rhythm, normal rate abdomen: soft, ntnd, no guarding gu: foley draining clear urine skin: cool, cvl subclavian in place ext: bka bilaterally, stump without erythema, wound discharge. neuro: lethargic but arousable, oriented to self, location, year discharge pe: vitals: t 97.9, bp 158/92, hr 74, rr 16, 100%ra lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: s1, s2 regular rhythm, normal rate, small systolic murmur at left sternal border abdomen: soft, ntnd, no guarding ext: bka bilaterally, stump without erythema, wound discharge. neuro: alert and oriented pertinent results: : klebsiella pneumoniae | amikacin-------------- =>64 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- =>64 r ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ r meropenem------------- =>16 r nitrofurantoin-------- 256 r piperacillin/tazo----- =>128 r tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r urine cx : no growth c. diff from : negative blood cx from negative cxr: impression: subsegmental atelectasis and/or scarring. cardiomegaly. no significant change. : ct contrast pelvis: impression: 1. multiple tiny calcifications at the renal hila are most likely vascular. possible small calculus in the right kidney, which is not causing any obstruction. 2. thick-walled bladder with intraluminal air, which may be due to recent instrumentation but could also be due to chronic cystitis. brief hospital course: 39 year old female multiple medical problems including type 1 diabetes, peripheral vascular disease s/p bka with multiple revisions (most recently ) and wound infections, esbl klebsiella urosepsis, c.diffile colitis presents with fever and hypotension. . #sepsis: she was admitted to the medical icu given her sirs criteria (fever, leukocytosis) and hypotension concerning for septic shock. there was suspicion of urinary source of infection given her risk factors and history of multi-drug resistant organisms. she was continued on broad spectrum antibiotics. her foley catheter was changed. the hypotension was fluid responsive and she did not require vasopressors. her antibiotics were narrowed to meropenem and po vancomycin to prevent c. diff colitis given her history. her urine ultiamtely grew pan-resistant klebsiella pneumonia. even though her urine was not sensitive to meropenem, she improved and had no further fevers. id was consulted for this complicated infection. she completed an entire 7 day course of antibiotics for her uti. #urinary incontinence: neurogenic bladder dysfunction from diabetes has put patient at higher risk for developed recurrent utis. urology was called and will meet with her outpatient to teach her cic and learn to self-catheterize herself to decrease her utis. urology will also present the idea of an appendicela conduit if patient continues to get repeated utis. pt went home with diapers until her appointment with urology in 1 day. . #history of c. diff colitis: she was noted to have large volumes of stool, although this was after receiving kayexcelate. c. difficile was sent and returned negative. she was continued emperically on po vancomycin while she was on antibiotics. . #acute renal failure: baseline creatinine of 1.1-1.2 with elevated creatinine to 1.5. likely pre-renal in setting of fever, poor po. her cr dropped with fluid hydration and it was 0.9 on day of discharge. . #hyperkalemia: pt's k was elevated on admission, most likely arf and lisinopril. lisinopril was held. cr improved with ivf. . #diabetes: patient had several episodes of hyperglycemia up to the 400s and hypoglycemia down to the 30s. she was put on an insulin sliding scale throughout her hospitalization with adjusted parameters based on her glucose level. pt has history of brittle diabetes per omr notes, likely explaining her range of glucose levels. pt told to continue her home insulin regimen and follow with . . #hypertension: her home metoprolol and lisinopril were initially held in seting of sirs on admission. metoprolol and lisinopril were added back after pts bp normalized. . #neuropathy: continued her home medications for neuropathy. medications on admission: 1. calcium acetate 667 mg capsule sig: one (1) capsule po daily (daily). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for anxiety. 4. gabapentin 400 mg capsule sig: one (1) capsule po three times a day. 5. lorazepam 0.5 mg tablet sig: one (1) tablet po twice a day. 6. morphine 15 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 7. metoprolol succinate 25 mg tablet sustained release 24 hr sig: four (4) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*0* 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 10. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 14. insulin glargine 100 unit/ml solution sig: four (4) units subcutaneous qam. 15. insulin glargine 100 unit/ml solution sig: one (1) unit subcutaneous qpm. 16. humalog 100 unit/ml solution sig: sliding scale units subcutaneous every six (6) hours. 17. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): last dose will be at the end of the day on . 18. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): last dose will be at the end of the day on . 19. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). discharge medications: 1. outpatient lab work please forward results to dr. fax# ad dr. . labs requested on (48 hours after discharge from hospital): 1)urine culture-aerobic, urine analysis with reflex sediment. 2)blood culture x 2. 2. calcium acetate 667 mg capsule sig: one (1) capsule po daily (daily). 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po twice a day. 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. morphine 15 mg tablet sig: one (1) tablet po tid prn as needed for pain. 9. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. insulin glargine 100 unit/ml solution sig: five (5) u subcutaneous daily in am. 13. humalog 100 unit/ml solution sig: use as directed units subcutaneous four times a day: use as directed according to your insulin sliding scale. 14. morphine 10 mg/5 ml solution sig: one (1) tablespoon po q3hrs prn as needed for pain. 15. b complex-vitamin c-folic acid 400 mcg tablet sig: one (1) tablet po once a day. 16. gabapentin 800 mg tablet sig: one (1) tablet po three times a day. 17. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q4hr prn as needed for pain. 18. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 19. trazodone 50 mg tablet sig: one (1) tablet po bedtime prn as needed for insomnia. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: urinary tract infection sepsis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure to care for you during your hospilization here at . you were admitted for a serious infection in your urinary tract that caused your body to drop it's pressure. you were initially sent to the intensive care unit until you stabalized. you were started on broad spectrum antibiotics to eliminate your urinary tract infection. you were treated with 7 days of meropenem antibiotic through your veins. the vascular surgeons examined the wounds on your leg and felt that they were healing well and that they were not the source of your infection. you got better during your hospitalization and stopped having fevers. the urology doctors saw and you try a new way to eliminate urine called: self catheterization. they look forward to teaching you this technique at an appointment on friday. by self-catheterizing yourself, you will eliminate your risk of having recurrent urinary tract infections. for now, please wear daily diapers to collect your urine until your urology appointment. you will see the infectious disease doctors in a days. beforehand, you must give a urine and blood culture specimen 1-2 days after your discharge from the hospital. idealy you would do this tomorrow, friday, which is the same day as your urology appointment. please bring the attached form with the presciption to get a urine culture and urine analysis along with a blood culture. you can get these labs drawn in the building on the day of your urology appointment. the following changes were made to your medications: -your blood pressure medications (metoprolol and lisinopril) were initially held when you were acutely sick. they were re-introduced during your hosptialization. you must continue to take these medications every day. -your gabapentin was held during your hospitalization. you can continue this medicine when you leave the hospital. -your trazadone was not given to you during your hospitalization. we gave you zolpidem to help you sleep. you can continue your normal sleep regimen when you go home. please continue all of your normal home medications, including your normal insulin regimen. at this point, you will not go home on any further antibiotics. you will have an appointment with your infectious disease doctor in the next few weeks to monitor you carefully for signs of infection. it is very important to continue your medications every day as well as your daily wound dressing changes. your dressing changes only require dry gauze to any wound that is oozing. all other wounds can be open to the air. please make sure you follow up with your primary care doctor, your infectious disease doctor, your new urologist and your vascular doctor. followup instructions: department: surgical specialties when: friday at 2:00 pm with: urodynamics study building: sc clinical ctr campus: east best parking: garage department: infectious disease when: tuesday at 9:30 am with: flash, md building: lm bldg () campus: west best parking: garage department: internal medicine when: monday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage department: infectious disease when: tuesday at 9:30 am with: flash, md building: lm bldg () campus: west best parking: garage name: , location: address: ste 5c, , phone: appointment: wednesday 12:30pm department: internal medicine when: monday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage md, procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia other chronic pain anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified hyposmolality and/or hyponatremia candidiasis of other urogenital sites polyneuropathy in diabetes peripheral vascular disease, unspecified depressive disorder, not elsewhere classified pure hyperglyceridemia other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction chronic systolic heart failure other postprocedural status other abnormal blood chemistry below knee amputation status urinary incontinence, unspecified diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use neurogenic bladder nos diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled systemic inflammatory response syndrome, unspecified 

Answer: The patient is high likely exposed to