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: codeine / percocet attending: chief complaint: abdominal pain, chills major surgical or invasive procedure: percutaneous nephrostomy tube placement history of present illness: ms. is a 75 y/o female with a h/o a recent episode of ischemic colitis, thyroid cancer and osa who initially presented to the er with complaints of sharp epigastric abdominal pain that radiated to her back, associated with nausea, shortness of breath, one episode of emesis and constipation. the patient was concerned that this pain could be her ischemic colitis recurrence or related to her worsening back pain so she called her doctor who referred her into the er. additionally she has been experiencing shaking chills overnight sunday and monday nights, she says that she woke up at 2am both nights with shaking chills and had difficulty sleeping from the chills. in the ed, initial vs were: 99.2, 84, 116/58, 16, 98% on ra. on examination by the resident she was noted to be febrile to 104.4 and rigoring, she was given acetaminophen and empirically covered with vancomycin and cefepime. additionally, she was found to have blood pressures that were discordant by 15mmhg in each arm and given her description of stabbing epigastric pain that radiated to her back and her h/o ischemic colitis she was sent for cta torso. the cta did not show any evidence aortic disection or ischemic colitis, but did show a large 1cmx1.4cm obstructing renal stone with associated moderate left hydronephrosis. urology was consulted who recommended urgent placement of a percutaneous nephrostomy tube with ir. she was also given 100mcg of fentanyl for pain and 8mg of zofran for nausea, a total of 2lns and admitted to the micu for further management. vs on transfer: 101.2, 96, 108/62, 24, 98% on ra. . on arrival to the micu, initial vs were: 98.3, 89, 104/59, 23, 98% on ra. shortly after her arrival to the micu her blood pressure fell to the 80's systolic, she was bolused 1l ns and taken to ir for percutaneous nephrostomy placement. the procedure was uncomplicated but on return to the micu was rigoring and uncomfortable. . review of systems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies diarrhea. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: paf ischemic colitis diastolic dysfunction with preserved ef aortic stenosis - per chart but not seen on tte obesity thyroid cancer vitamin d deficiency hypothyroidism barrett's esophagus htn hypercholesterolemia obstructive sleep apnea social history: lives alone, independent. retired executive director of an organization. no tobacco, occasional alcohol, no illicits. family history: no known fhx of colon cancer physical exam: admission exam general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge exam pertinent results: admission labs 04:50pm blood wbc-10.5# rbc-4.52 hgb-13.2 hct-43.1 mcv-96 mch-29.2 mchc-30.5* rdw-14.4 plt ct-188 04:18am blood neuts-88.1* lymphs-7.6* monos-2.9 eos-1.2 baso-0.2 06:30pm blood pt-13.2* ptt-29.1 inr(pt)-1.2* 04:50pm blood glucose-110* urean-23* creat-1.1 na-140 k-4.1 cl-105 hco3-20* angap-19 04:50pm blood alt-15 ast-30 alkphos-82 totbili-0.8 02:04am blood calcium-8.5 phos-2.7 mg-1.6 06:38pm blood lactate-1.5 06:35pm urine color-yellow appear-hazy sp -1.012 06:35pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-40 bilirub-neg urobiln-2* ph-6.0 leuks-lg 06:35pm urine rbc-5* wbc-124* bacteri-few yeast-none epi-2 microbiology blood culture, routine (final ): escherichia coli. final sensitivities. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). . blood cultures 4/4,- ngtd . urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. . 11:41 pm urine,kidney source: kidney. **final report ** fluid culture (final ): escherichia coli. >100,000 organisms/ml.. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 32 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . studies ekg sinus rhythm. left axis deviation with left anterior fascicular block. left ventricular hypertrophy by voltage criteria. non-diagnostic q waves in the lateral limb leads. early anterior r wave transition. intraventricular conduction delay. compared to the previous tracing of , t wave ampitude is improved in the inferolateral leads. depolarization patterns are similar. . cta chest abdomen pelvis 1. moderate left hydronephrosis secondary to a 14 x 10 mm obstructing stone in the pelviureteric junction. additional non-obstructing left renal stone in the upper pole. possible superimposed infection in the left renal collecting system. 2. no evidence of aortic dissection or bowel ischemia. 3. unchanged stenosis of the celiac origin, with likely retrograde flow in the distal celiac trunk. 4. aneurysms of the pancreaticoduodenal artery, stable since the recent study of , but slightly larger since the earliest study of . 5. extensive sigmoid colonic diverticulosis without evidence of acute diverticulitis. brief hospital course: ms. is a 75 y/o f with a recent history of ischemic colitis, cad, osa not on home bipap who presented with abominal pain found to have an obstructing renal stone, urinary tract infection and sepsis. . #) sepsis due to uti: urinary tract infection/pyelonephritis as the primary source from the obstructive renal stone, found to have high grade e.coli bacteremia. on the night of admission underwent emergent percutaneous nephrostomy tube placement, for decompression with drainage of pus, that also grew out e.coli. her first night in the icu was complicated by significant hypotension that was iv fluid responsive requiring large volume fluid resuscitation. she was initially broadly covered with vancomycin and cefepime, the vancomycin was discontinued when her blood cultures grew out gnr's. over the next twenty four hours her blood pressure stabilized she was able to be called out the icu to the general medical floor. on the general medical floor her antibiotics were narrowed to ceftriaxone for a planned 2 week course from first negative culture. pressures remained stable and patient was discharged home with iv antibiotic therapy to complete a 14 day course of ceftriaxone (cipro was deferred given the flecainide cross reactivity and possible gut edema from her chf). she will then transition to po bactrim to be continued until she has definitive management of her stone. additionally infectious disease has recommended iv ceftriaxone (1 dose) in the peri-procedure period. . #) obstructing renal stone: large renal stone on ct 1.4cm x 1cm, percutaneous nephrostomy tube was placed on the night of admission. urology was consulted, they initially recommended percutaneous nephrostomy tube placement and outpatient follow up once her infection had resolved for discussion about removal of her stone. she will follow-up with dr. . . #) acute renal failure: moderate amount of hydronephrosis on the left, cr still within normal limits but up from her baseline of 0.6 to 0.7. improved with aggressive iv fluid resuscitation, initially thought to be due to prerenal with the improvement with iv fluids and remained stable throughout the remainder of her admission. . #) acute diastolic chf- on transfer to the floor the patient was noted to be markedly volume overloaded. this was attributed to the large amount of fluid received in the icu. once on the general medicine floor pressures stabilized and she diuresed with 20 mg bolus doses of iv lasix. in total she was diuresed 13 l over 6 days. her weight on discharge was 304 lbs (max weight 331.5 lbs). she was restarted on her home oral lasix at the time of discharge. . stable issues #) paroxysmal af: continued her home flecanide and asa but held her metoprolol in the icu given her hypotension. this was restarted on the floor . #) hypertension: hypotensive in the icu so held her home antihypertensives. her home antihypertensives were restarted prior to discharge. . #) hypothyroidism: patient was continued on her home synthroid . transitional issues - blood cultures were pending at the time of discharge - patient will follow-up with urology and her pcp /dni medications on admission: -ergocalciferol 50,000 unit three times monthly -flecainide 100 mg twice a day -furosemide 20 mg once a day -levothyroxine 200 mcg daily -lisinopril 10 mg once a day -metoprolol succinate 12.5mg once a day -omeprazole 20 mg once a day -rosuvastatin 5mg once a day -venlafaxine 37.5 mg once a day -aspirin 325 mg once a day -benefiber twice a day discharge medications: 1. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 2. venlafaxine 37.5 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po daily (daily). 3. flecainide 100 mg tablet sig: one (1) tablet po twice a day. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 3 times a month. 7. lasix 20 mg tablet sig: one (1) tablet po once a day. 8. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 9. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po once a day. 10. rosuvastatin 5 mg tablet sig: one (1) tablet po once a day. 11. benefiber (wheat dextrin) 1 gram tablet sig: one (1) tablet po twice a day. 12. loratadine-pseudoephedrine 10-240 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day as needed for allergy symptoms. 13. bariatric rolling walker 14. outpatient lab work please check cbc with diff, chem-7 and lfts on and fax results to dr at 15. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 7 days. disp:*7 gram * refills:*0* 16. bactrim 400-80 mg tablet sig: one (1) tablet po twice a day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary diagnosis nephroliathisis sepsis secondary diagnosis obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms , it was a pleasure participating in your care while you were admitted to . as you know you were admitted with with fevers and pain. a ct scan was done which showed a kidney stone that was blocking the tube leading from your kidney to your bladder. a drain was placed to remove this blockage. the fluid from the drain showed an infection. you also grew bacteria in your blood. you were given antibiotics through the iv which you will need to continue for 7 more days. you will then be switched to oral antibiotics. you received a special iv called a picc line so that you can get these antibiotics at home. the drain will need to stay in place until you see the urologist dr. will need to remove the kidney stone. we made the following changes to your medications 1. start ceftriaxone 2 gram daily for 7 more days 2. start bactrim 1 ss tablet twice a day once you finish iv antibiotics (first day ) until the urologist does a procedure to remove the stone you should continue to take your other medications as instructed. please feel free to call with any questions or concerns. followup instructions: department: bidhc when: tuesday at 2:00 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: surgical specialties when: wednesday at 4:00 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified percutaneous nephrostomy without fragmentation central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis atrial fibrillation septic shock morbid obesity do not resuscitate status acute diastolic heart failure septicemia due to escherichia coli [e. coli] hydronephrosis calculus of kidney unspecified vitamin d deficiency postsurgical hypothyroidism personal history of malignant neoplasm of thyroid pyelonephritis, unspecified benign essential hypertension other ureteric obstruction 

Answer: The patient is high likely exposed to