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: dizziness major surgical or invasive procedure: ercp - complicated by ampullary bleeding for which 3u prbc was given. history of present illness: 66 yo m radiologist with cholangiocarcinoma s/p stents in and follow-up ercp that showed 20 mm malignant stricture who presented to oncologist with ruq pain and presyncope. found to be tachy with increased wbc -- ? cholangitis. sent in for ercp -- at time of ercp, had large amount of bleeding requiring expanding stent to tamponade bleed. admitted to for observation. in , he received 3 units of prbcs. hct was 24.8 on admission and now is 29.5 as of 3 pm this afternoon. no longer tachy with stable bp. no evidence of current bleeding. given vanco/zosyn for ? cholangitis. vitals currently in : 104 121/71 99% on ra. no current complaints. at time of transfer -- 2 18 gauges and a 20 gauge. past medical history: pmh: dm, cholangiocarcinoma - s/p double pigtail stents in psh: ptc placement () social history: no alcohol use, smoking, iv drug use, marijuana use, blood transfusions, tattoos, hepatitis, or piercing. married, works as a radiologist, originally from . he has two children. one son is a physician in and dtr is engineer. family history: mother died of tuberculosis, father of natural causes, sister of hcc physical exam: on =99.1 bp-118/68 hr=87 rr=20 sao2 99% ra thin man in nad heent-negative neck-no masses or jvd lungs-decreased breath sounds halfway up on the right, otherwise ctab cv-rr, no m/r/g abd-soft, nt, no, nabs. we-helaed scar in ruq extrem-warm, well-perfused, no edema, no calf tenderness neuro-non-focal screening exam ros: reports bloody stool immediately post the ercp yesterday, but no stool since. no abd pain. no nausea. pertinent results: 09:00am blood wbc-23.8*# rbc-2.78* hgb-7.8* hct-24.8* mcv-89 mch-28.2 mchc-31.6 rdw-18.6* plt ct-470*# 03:03pm blood wbc-17.2* rbc-3.54* hgb-10.1* hct-29.5* mcv-83 mch-28.4 mchc-34.2 rdw-16.7* plt ct-290 09:00am blood neuts-93* bands-5 lymphs-1* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 09:00am blood gran ct-* 09:00am blood urean-19 creat-0.7 na-134 k-5.1 cl-95* hco3-27 angap-17 03:58am blood glucose-125* urean-17 creat-0.7 na-135 k-3.6 cl-100 hco3-29 angap-10 09:00am blood alt-82* ast-126* alkphos-320* amylase-53 totbili-1.8* dirbili-1.4* indbili-0.4 03:58am blood alt-66* ast-81* ld(ldh)-115 alkphos-237* amylase-108* totbili-8.2* 09:00am blood albumin-3.2* calcium-9.1 phos-3.4 mg-1.4* 03:58am blood calcium-8.6 phos-3.3 mg-2.5 uricacd-1.7* 09:00am blood ca -9 -pnd ercp : impression: two double pigtail plastic stents previously placed in the biliary duct were found in the major papilla the stents were removed with a snare and a rat tooth forceps evidence of a previous sphincterotomy was noted in the major papilla cannulation of the biliary duct was successful and deep with a balloon sphincter using a free-hand technique. time taken not noted log-in date/time: 1:59 pm blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. ertapenem susceptibility testing requested by dr. (). sensitive to ertapenem , sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- =>64 r cefepime-------------- r ceftazidime----------- r ceftriaxone----------- r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r aerobic bottle gram stain (final ): reported by phone to dr. on at 0145. gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). multiple irregular filling defects were noted in the cbd, chd and the right and left main intrahepatic ducts pus and clots were extracted with balloon sweeps from the cbd, chd and the left main intrahepatic ducts. large amount of bright red bleeding was noted after the last balloon sweep. the 15mm balloon was positioned in the distal cbd and inflated to provide tamponade the balloon was deflated after approximately 10 minutes with complete cessation of bleeding. at this time, to provide continued hemostasis and re-establish biliary drainage, a fully covered wallflex biliary metal stent 10mm x 80mm was placed in the bile duct extending down from the left side of the hilar bifurcation. no further bleeding was noted. recommendations: pt will be admitted to the icu for monitoring if further bleeding occurs, pt will need angiography no aspirin or nsaids continue with broad coverage iv antibiotics 09:05am blood wbc-8.2 rbc-3.29* hgb-9.8* hct-28.9* mcv-88 mch-29.7 mchc-33.7 rdw-16.8* plt ct-236 03:58am blood alt-66* ast-81* ld(ldh)-115 alkphos-237* amylase-108* totbili-8.2* 08:10am blood alt-64* ast-73* ld(ldh)-146 alkphos-276* totbili-4.5* 09:05am blood alt-61* ast-64* alkphos-287* totbili-3.1* 10:24am blood alt-60* ast-62* alkphos-282* totbili-2.8* 09:00am blood ca -9 -test pending brief hospital course: dr. is a 66 year-old gentleman with locally-advanced cholangiocarcinoma who underwent ercp due to concern for evolving cholangitis, with bleeding after stent manipulation, who was transferred to the icu for monitoring after tamponade with expanding stent in effort to control bleeding from the billiary tree (see ercp report).he was transferred to the medical floor on . . #. bleeding from ampula: pt was mildly tachy at presentation to and while this resolved somewhat was still midly tachy at time of call out. maintained bp during course. pt received 2 l ns and 2 units prbc at evening of presentation with hct going from 24.8 to 28.1. on the am of pt had a 700cc melanotic bm. the ercp team was notified and stated that most likely this was blood in stool from bleeding that had been cause during proceedure and not indicative of a new bleed. this correlated with the clinical situation. pt was given 5mg vit k for slightly elevated inr of 1.7. he received another unit of prbc for a total of 3 units during icu course with f/u hct 29.5. antiplatelet agents were held while in icu. at time of call-out to floor there was no evidence of active or large volume bleeding and pt had improvement in abdominal pain. pt did have elevated tbili from 1.8 -> 8.2 likely to bleeding and biliary dysfunction from the regional trauma related to the proceedure. pt was transitioned to clears on am of , however, pt was told that solid foods would be held until he was a little futher out from his ercp. full liquid diet with diabetic restrictions were started in the evening of . . #. cholangitis w/ bacteremia: leukocytosis, hyperbilirubinemia, ruq pain - likely from cholangitis. was tachycardic with low-grade fever, concerning for sepsis. he was covered for gn/anaerobes with zosyn and gp/mrsa with vanco. clinic blood cx from came back with gram negative rods which speciated as esbl e. coli on sensitive to meropenem on which he was started. this will be continued for 14 days to . wbc normalized. ercp team saw him and removed previously placed stents from the cbd. his lfts trended downwards. a picc line was placed and he will continue antibiotics as instructed via homeinfusion. . #. tachycardia: likely due to underlying infection and possibly volume depletion. pt remained intermittently in mild sinus tach while in unit. was hovering around 100 at time of call-out. was given ivf initially. pressures stayed stable during icu stay. telemetry was continued on the medical unit. tachuycardia resolved with resoumption of diet. . #. diabetes mellitus type ii: oral hypoglycemics were held and pt was maintained on iss. oha resumed on discharge. . #. cholangiocarcinoma: no acute issues st this time. pt is followed by dr. and dr. . he is s/p chemo with gemcitabine and cisplatin last dose on . pt will follow up on this as outpt. uric acid was mildly supressed at 1.7. medications on admission: glucophage 1gm glimepirde 2gm daily discharge medications: 1. glimepiride 2 mg tablet sig: one (1) tablet po once a day. 2. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 3. ertapenem 1 gram recon soln sig: one (1) gram injection once a day for 12 days: last dose . disp:*12 gram* refills:*0* discharge disposition: home with service facility: , discharge diagnosis: cholangitis esbl e. coli bacteremia gi bleeding post ercp (ampullary bleed) s/p 3u prbc cholangiocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with cholangitis and recurrent biliary obstruction. you underwent ercp with retrieval of previously placed cbd stents on . this was complicated by ampullary bleeding for which you recevied 3u prbc and were observed in icu. you were subsequently found to have bacteremia with extended spectrum beta lactam (esbl) resistant e. coli infection for which meropenem was initiated on after empiric treatment with vancomycin and zosyn from to . this will change to once daily ertapenem on discharge and should continue through . i have verbally updated your pcp office so that they are aware, and will fax a copy of your discharge summary to them. followup instructions: follow up with ercp team who will be in touch with you with follow-up appointment information as needed. procedure: venous catheterization, not elsewhere classified endoscopic dilation of ampulla and biliary duct replacement of stent (tube) in biliary or pancreatic duct diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hemorrhage complicating a procedure other specified cardiac dysrhythmias bacteremia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cholangitis obstruction of bile duct malignant neoplasm of intrahepatic bile ducts 

Answer: The patient is high likely exposed to