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: dka and hypotension in the setting of an unwitnessed fall major surgical or invasive procedure: none history of present illness: ms. is an 82yo woman with h/o dementia, dm, afib and dvt on coumadin as well as recurrent admissions for cholangitis and hypernatremia with h/o utis and cdiff presenting after being found down at her nursing home at 5:15 am. per report, it is unclear how long she may have been on the floor. she had a hematoma on the r forehead with "large frank bleed." last inr was 1.8 on ; pt was still receiving lovenox. at time, fsbs was 294. she did not receive novalog at this time. she did receive lantus 20 units the previous night. in the ed, initial vs were: 97.8 rectal, 143/78, 73, 98% on ra. she was oriented to self only. the patient was able to answer her name, her daughters, that she has no pain. she denied headache, vision problems, chest pain, sob, cough, n/v, abdominal pain. she received 3l of ns and was treated for possible infection with levofloxacin, flagyl, and vancomycin. she was given 6 units of iv insulin and started on a gtt at 6 units/hr. she was also given a tetanus shot and had stitches for her scalp laceration. the patient was transferred to the icu for management of dka. of note, the patient was recently admitted for hypernatremia due to poor free water access. she also underwent on for recurrent cholangitis: a pig tail catheter was placed for drainage with the plan to remove the catheter in and continue to monitor the patient clinically. past medical history: pmh last updated - cholilithiais and choledocholithiasis with recurrent admissions for ascending cholangitis s/p /stents, perc chole. last stent placement, removed on with more stone extraction and another stent placed. - recurrent c.diff and - paroxysmal afib -on coumadin - dvt on coumadin, dx , l common femoral, still present - dm2 on insulin - htn - recurrent admission for dehydration/hypernatremia - recurrent utis with mdr organisms (ecoli, pseudomonas-?colonizer)-on chronic foley - dysphagia-dx , on pureed diet with nectar thicks, 1:1 supervision, aspiration precautions - osteochondroma of l knee as a child - mvp - alzheimer's disease - severe, baseline speaks to self, doesnt recognize people - sacral decub (stage iv) and bilateral heel (stage iii) pressure and deep tissue wounds - severe knee arthitis-bed bound - anemia-?acd, baseline h/h - s/p right orif of hip fracture at age 75 social history: not currently smoking, alcohol or illicit drug use. lives in a high gate manor . fully dependent on all adls. mostly bed bound due to severe knee arthritis and deformity. family history: daughter with arthritis, father died of hepatitis c from a blood transfusion. mother died at age 86 of a myocardial infarction. son with hypertension. physical exam: vs: gen: elderly female with dementia, appears comfortable, nad. non-toxic. heent: eomi, mmm. anicteric. resp: mild basilar rales b. cv: rrr. 2/6 sem. abd: +bs. soft, nt/nd. ext: pressure relieving boots in place. no edema. r heel with stage 2 ulcer. neuro: a+o x self. interacts with environment, but not appropriate. at times with paucity of speech, at other times with signif non-sensical talking. able to move all 4, but does not reliably follow commands. will follow some commands with repeat prompting. mild l facial droop. skin: large stage iv sacral decub. +stage ii r heel ulcer. pertinent results: 06:50am ck-mb-3 ctropnt-0.03* 06:50am glucose-420* urea n-20 creat-1.2* sodium-139 potassium-4.3 chloride-107 total co2-15* anion gap-21* 08:31am urine color-straw appear-hazy sp -1.010 08:31am urine blood-lg nitrite-pos protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 07:00am pt-22.0* ptt-32.5 inr(pt)-2.1* 07:00am wbc-16.8*# rbc-3.79* hgb-9.5* hct-31.9* mcv-84 mch-25.1* mchc-29.9* rdw-15.8* . 06:55am blood wbc-6.1 rbc-3.38* hgb-8.6* hct-27.7* mcv-82 mch-25.3* mchc-30.9* rdw-17.8* plt ct-271 . 07:00am blood pt-22.0* ptt-32.5 inr(pt)-2.1* 04:31am blood pt-20.3* ptt-36.9* inr(pt)-1.9* 01:25pm blood pt-15.7* inr(pt)-1.4* 06:55am blood pt-14.3* ptt-24.1 inr(pt)-1.2* . 06:55am blood glucose-93 urean-13 creat-0.7 na-141 k-3.8 cl-112* hco3-22 angap-11 06:55am blood calcium-7.6* phos-2.3* mg-1.6 01:25pm blood alt-9 ast-14 alkphos-97 totbili-0.4 . 06:50am blood ck-mb-3 ctropnt-0.03* 12:50pm blood ck-mb-5 ctropnt-0.03* 08:00pm blood ck-mb-6 ctropnt-0.03* . 03:58am blood caltibc-196* ferritn-56 trf-151* . 08:31am urine color-straw appear-hazy sp -1.010 08:31am urine blood-lg nitrite-pos protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-mod 08:31am urine rbc-* wbc->50 bacteri-many yeast-mod epi-0-2 . urine micro: urine culture (final ): escherichia coli. >100,000 organisms/ml. of two colonial morphologies. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 4 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r . c-diff negative x 1 . blood cultures pending x 3 . head ct impression: right scalp laceration. no acute intracranial hemorrhage. . ct c-spine: impression: 1. no sign of cervical spine fracture or acute malalignment. degenerative changes as detailed above. 2. hypodense foci in the thyroid, as described above, largest 1.5x0.6cm posterior to the isthmus, needs further evaluation with us on a non-emergent basis. . xray foot: findings: patient is extremely demineralized which limits evaluation for subtle fractures. allowing for this, no displaced fractures are seen. there is severe hallux valgus metatarsus varus of the first mtp joint with degenerative changes. there are deformities of the shaft of the second and fourth metatarsals suggestive of prior old fracture with subsequent healing. no bony erosions are seen. . xray pelvis: impression: no fracture. . cxr: impression: no acute cardiopulmonary abnormality. . ekg: sinus rhythm low inferolateral lead t wave amplitude is nonspecific since previous tracing of , sinus tachycardia absent and st-t wave changes decreased . ct abd/pelvis: impression: 1. no abnormal fluid collections that would be concerning for retroperitoneal hemorrhage 2. known deep venous thrombus involving the left common iliac vein is not well seen on this non-contrast examination 3. markedly abnormal appearance of the gallbladder not significantly changed since more fully characterized on prior contrast enhanced study. 4. moderate-sized sliding hiatal hernia. 5. incompletely characterized 18 x 16-mm right ovarian rounded lesion that if of clinical concern, a pelvic ultrasound can be performed for further characterization. 6. common bile duct stent in place with biliary tree air likely post- procedurally related. brief hospital course: 82 yo female with hx of dementia, t2dm on insulin, afib, hx dvt, hx of cholangitis, uti's, c-diff, presented after being found down in her nursing home with r frontal hematoma with urosepsis and dka. pt was initially admitted to the icu where she was found to be uroseptic with hypotension. she was initially treated with vanc, pip/tazo, and flagyl, as well as ivf boluses for hypotension. her urine culture later revealed e.coli, and antibiotics were narrowed to pip/tazo. on the medicine floor, this was later changed to cefpodoxime based upon culture sensitivities, with plans to complete a 14 day course. her wbc had normalized and she remained afebrile at the time of discharge. . # dka: patient was found to be in dka at the time of admission with an anion gap of 21 and glucose of 420. this was treated with ivf boluses, and insulin drip initially. she was converted to lantus and sliding scale insulin after her anion gap closed and her glucose levels were well controlled. . # anemia, unspecified: patient's h/h was followed closely throughout the hospitalization, as her h/h appeared to slowly drift down. she was found to be weakly guiac positive in the icu, but her stools remained brown and without evidence of clinically significant gib. pt rec'd 2 units prbc in icu. . # hypotension: upon hospitalization and throughout the patient's stay in the icu, she had multiple episodes of low blood pressure. her hypotension was most likely thought to be multifactorial including hypovolemia from poor po intake complicated by hyperglycemia, sepsis, acute blood loss. patient was transferred to the medicine floor, and her blood pressure remained stable. . # s/p fall: likely due to urosepsis/dka/hypovolemia. ct head/neck, xray foot and pelvis were negative for fracture (see reports for findings). . # st depressions on ekg: although she did not c/o chest pain, she is not a reliable historian. serial ekgs and cycled troponins were done to rule out acs. her cardiac enzymes showed trpt of 0.03, but ck-mb remained negative. . # arf: baseline cr 0.7-0.8, pt was noted to have acute renal failure on admission, with bun/cr max 20/1.2. this resolved to previous baseline of 13/0.7 at time of discharge. . # scalp laceration: repaired in ed and tetanus shot given. patient will likely need sutures out in 1 week . # left common femoral dvt diagnosed : patient is on coumadin as an outpt. this was held due to concerns of significant anemia in the icu that required transfusion of 2 units prbc. on the medicine floor, coumadin was resumed, as h/h appeared more stable. goal inr=2. . # h/o hypernatremia/dehydration: it was noted that patient has a history of recurrent hypernatremia because of dementia and poor water intake. her sodium was monitored and reached a maximum of 148, but then normalized and remained stable. the patient may require reminders to take adequate oral hydration. . # sacral decubitus ulcer and heel ulcer: the patient was noted to have a stage iv large coccygeal ulcer and a stage iii r heel ulcer. wound care was consulted and assisted with managing of wound. . # history of recurrent choledocholithiasis/cholangitis s/p ercps/stent: patient has a pigtail placed . - has repeat scheduled in . # afib on coumadin: currently in nsr. - diltiazem is currently being held due to concerns of hypotension in the icu. her hr remained well controlled, and pt did not become hypertensive. please resume if hr or bp become elevated. coumadin was initially held due to concern about anemia requiring 2 units prbc. this was resumed when her h/h appeared stable. . # alzheimer's dementia: severe, at baseline. . # fen: diabetic diet with pureed diet, nectar thicks, 1:1 assistance, hob elevated, oral care , aspiration precautions. patient needs to be fed - eats very well. . # health care proxy: daughter is , ph: . . # code: full code (confirmed on recent admission ) medications on admission: warfarin 3 mg daily glargine 20 units qhs lispro sliding scale diltiazem 120 mg daily zinc sulfate 220 mg daily ascorbic acid 500 mg hydrocodone-acetaminophen 5-500 mg q8h docusate sodium 100 mg senna 8.6 mg prn alum-mag hydroxide-simeth 200-200-20 mg/5 ml 15-30ml qid prn magnesium hydroxide 400 mg/5 ml 30ml q6h prn constipation. enoxaparin 60mg subcutaneous q12h until inr is between 2.0 and 3.0 for at least 24 hours and then stop. discharge medications: 1. cefpodoxime 100 mg tablet : two (2) tablet po q12h (every 12 hours) for 10 days. tablet(s) 2. psyllium 1.7 g wafer : one (1) wafer po daily (daily). 3. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain. 4. warfarin 2 mg tablet : one (1) tablet po once daily at 4 pm: goal inr=2. 5. insulin glargine 100 unit/ml solution : one (1) 20 subcutaneous once a day. 6. zinc sulfate 220 mg tablet : one (1) tablet po daily (daily). 7. ascorbic acid 500 mg tablet : one (1) tablet po bid (2 times a day). 8. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 10. insulin lispro 100 unit/ml solution : one (1) 2-10 units subcutaneous three times a day: with breakfast, lunch and dinner based on sliding scale for blood glucose > 200. discharge disposition: extended care facility: health care discharge diagnosis: # urosepsis; e.coli # diabetic ketoacidosis # anemia, unspecified # recent dvt, on coumadin # paroxysmal atrial fibrillation # alzheimer's disease, severe discharge condition: stable discharge instructions: you were admitted to after a fall, with the findings of urosepsis and dka. you were initially managed in the icu with iv antibiotics and insulin, and then transitioned to sq insulin and oral antibiotics. . please take your medications as prescribed. it is important that you complete your course of antibiotics and keep good control of your blood sugars with your insulin. followup instructions: provider: 2 (st-4) gi rooms date/time: 10:00 provider: , md phone: date/time: 10:00 . imaging findings that may require follow up: hypodense foci in the thyroid, largest 1.5x0.6cm posterior to the isthmus, needs further evaluation with us on a non-emergent basis. . incompletely characterized 18 x 16-mm right ovarian rounded lesion that if of clinical concern, a pelvic ultrasound can be performed for further characterization. procedure: closure of skin and subcutaneous tissue of other sites diagnoses: hyperpotassemia anemia of other chronic disease urinary tract infection, site not specified acute kidney failure, unspecified severe sepsis atrial fibrillation open wound of forehead, without mention of complication long-term (current) use of insulin long-term (current) use of anticoagulants pressure ulcer, lower back personal history of venous thrombosis and embolism alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance pressure ulcer, heel hyperosmolality and/or hypernatremia accidental fall from bed septicemia due to escherichia coli [e. coli] pressure ulcer, stage iv contusion of face, scalp, and neck except eye(s) diabetes with ketoacidosis, type ii or unspecified type, uncontrolled personal history of methicillin resistant staphylococcus aureus personal history, urinary (tract) infection arthropathy, unspecified, lower leg 

Answer: The patient is high likely exposed to