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: ipratropium attending: chief complaint: hypotension major surgical or invasive procedure: r ij cvl placement history of present illness: yo demented nh resident with chf (ef 15%), cri (cr 1.0-1.3), cad s/p stents, dm who presents with labored breathing, hypotension, diaphorisis, and confusion, suspected to have urosepsis. . pt was in usoh at . noon fingerstick 327 and he received 8 units regular insulin. at approximately 2:15 pm he was noted to be poorly responsive, diaphoretic, and with labored breathing. his systolic bp was 70, hr >110, he had a loose bm. 02 sat on ra was 80% increased to 92% with 2l nc. he is a full code and family requests evaluation so pcp sent him to ed. . of note, pt was recently admitted from to with unresponsiveness and fever. he required intubation in the ed due to thick secretions versus mucus plugging. he was empirically treated with vancomycin and zosyn for pna. extubated on , but required regular airway suctioning. on the floor, he deveolped new pna (aspiration vs hap). abx were changed to ceftazidime, flagyl and iv vancomycin was continued. the patient defervesced and his leukocytosis resolved. during his stay, he also had coag neg staph tlc infection. he was followed by id and it was decided to cover him broadly with vanc, ceftax, flagyl for 14 day course which he completed on . . his course was c/b by nstemi on admission that was managed conservatively. heparin gtt stopped due to gib, hct remained stable at 25. also af/rvr responsive to iv bb, and arf on chronic, improved with ivf. furthermore, chf exacerbation with ef of % (previously 20% in 9/). found to have thrombi on the echo that decreased in size on repeat echo. not a candidate for anticoagulation given gib. on the floor, again acute resp distress. bnp of over . he was aggressively diuresed and discharged on 100 po lasix daily. improved. . in the ed, his vs were t104, 106, 95/63, 36, 99%nrb. unresponsive on exam. an ekg showed old std i, avl. cxr was unremarkable. head ct without acute change. wbc up with left shift. lactate 2.2 -> 3.8. ua positive. hypotensive to .80s/50s. received total of 1l ivf. code sepsis was called. r ij was placed after two attempts. vanc, zosyn, flagyl given and admitted to icu. . on arrival, pt was still unresponsive, satting well on nrb. past medical history: 1. cri- baseline creatinine 1.0 -1.3 2. cad- h/o ami s/p ptca to proximal lad 3. chf- tte with ef 15% 4. htn 5. dementia - mostly nonverbal, baseline is pleasant, alert and confused (chronic microvascular infarcts) 6. osteoporosis 7. type 2 diabetes mellitus 8. mild oropharyngela dysphagia --> thin liquids, pureed solids 9. h/o vasovagal syncope in setting of infections 10. h/o av blocks and bundle branch blocks in setting of infections 11. h/o multiple pnas 12. acute cholecystitis s/p perc cholecystostomy tube placement social history: lives in nursing home, apparently has two caregivers who are very involved heavy tobacco use in past, but quit ~20 years ago, no etoh. daughter: ( family history: nc physical exam: vitals- t 96.4, bp 92/59, hr 67, rr 23, o2sat 99% nrb general- elderly man lying in bed, nonresponsive heent- ncat, perrl, eomi, sclerae anicteric, very dry mucous membranes neck- no significant jvp, no neck stiffness pulm- ctab anteriorly cv- rr, nl s1, s2, no obvious murmur appreciated abd- sparse bs, nt, nd, soft extrem- no le edema, dp pulses 1+ bilaterally, feet cool neuro- nonresponsive to shouting, sternal rub or painful stimuli, mild b/l ue rigidity, dtrs 0-1+ throughout, toes downgoing pertinent results: on admission notable for positive ua, wbc of 18 with left shift. lactate of 2.2 ->3.8. hct of 22 (on repeat 40 and 43). inr of 1.4. . stool: c diff positive, stool culture otherwise negative ucx : pseudomonas, resistant to zosyn, sensitive to meropenem bcx: negative . ekg- st at 109, lad, ivcd, old std i,avl . head ct in ed: age-related changes, stable from the prior examination. no ct evidence for acute intracranial process. . cxr in ed: no evidence of pneumonia or chf. . cardiac echo : ef 15-20%. dilated, severely hypokinetic left ventricle with a left ventricular thrombus. compared with the prior study (images reviewed) of , the previously seen apical thrombus is not seen (although the apex is not well visualized). the previously seen inferior apical thrombus now measures 1.0 x 1.6cm (previously measured as 1.5cm x 1.7cm). the pulmonary artery systolic pressure is slightly higher on the current study. r picc placed under ultrasound guidance on . brief hospital course: hospital course by problem: 1. sepsis -uti and cdiff colitis: patient was hypotensive and unresponsive at rehab. found to have urosepsis with pseudomonas growing from urine and severe c difficile colitis. bb and lasix were held when patient was initially hypotensive. he responded to 15 litres total of ringers lactate boluses. he was initially on iv vancomycin/pip-tazo, and then iv metronidazole and po vancomycin were added on for severe c. difficile colitis. iv vancomycin was discontinued on due to lack of gram positive culture data. his piperacillin-tazobactam was changed to meropenem on when his uti pseudomonas returned as resistant to zosyn but sensitive to meropenem, and he will need to complete a 2-week course for urosepsis wiht last day on . he will then need to complete an additional 2-weeks of oral vancomycin 250mg po q6 hours and oral metronidazole 500mg po q8 hours up until 2 weeks after the completion of the meropenem (last day ). patient's blood pressure normalized with fluid boluses and furosemide and metoprolol were resumed after this. picc line was placed under fluoroscopy for antibiotic administration. 2. respiratory distress: in setting of sepsis and poor ef. cxr clear. o2 sats remained stable on 3l nc. he received prn nebulizers. furosemide was resumed after achieving adequate fluid resuscitation. he is currently on furosemide 100mg po qday. 3. ams: reportedly a&ox2 at baseline, improved with treatment of sepsis. head ct was wnl. tsh, b12, folate were wnl. hypernatremia was improved. patient became responsive and gives one word ansewrs to questions. 4. arf: resolved with ivf. baseline creatinine 1.2-1.4. cr of 2.0 on admission, improved back to baseline after aggressive iv fluids consistent with prerenal etiology. 5. cad: history of stents. ekg without acute changes. recent nstemi during last admission in setting of gi bleed on heparin gtt. in ed, trop 0.03, then 0.07, then 0.09 in micu, thus not significantly elevated despite arf. he was continued on asa. bb was initially held in setting of sepsis and restarted due to recurrent ventricular ectopy on telemetry. he was started on a dose of 6.25mg po bid, which is lower than his admission dose of 12.5mg po bid, and this will need to be uptitrated as tolerated as outpatient. we also held his captopril during his stay due to borderline blood pressure. this should be restarted and titrated as an outpatient as his blood pressure improves. 6. acute on chronic systolic chf: ef of 15%. recent chf exacerbation. on 100 lasix po daily on discharge from last hospitalization, at rehab down to 30 daily. lasix and bb were held initially and were restarted due to positive fluid balance after resuscitation. 7. anemia: hct baseline 25. in ed, hct first 22, then 40-43 after initial resuscitation, eventually down to ~30 with iv fluids. 8. diabetes mellitus: patient was transiently on insulin drip in the setting of sepsis. his tube feeds was resumed and his regimen was adjusted with sliding scale and glargine 30 units at breakfast. this will need to be further titrated as outpatient, as his admission dose was insulin glargine 6 units qam and 35 units qhs. 9. dementia: his memantine and donepezil were continued throughout his stay. 10. nutrition: tube feeds were continued with free-water boluses for hypernatremia. 11. prophylaxis: patient received pantoprazole and heparin subcutaneously while in house. 12. access: right-internal jugular triple lumen catheter was initially inserted then changed to a picc line. picc line will need to be pulled after completion of flagyl course. 13. code status: full code, confirmed with health-care proxy 14. communication: - wife - daughter (hcp) ( - caregivers: and of generations nh - 617 the patient was stable on the day of discharge and is discharged back to . medications on admission: 1. albuterol q4h (every 4 hours). 2. albuterol q2h prn 3. polyvinyl alcohol-povidone ophthalmic prn (as needed). 4. heparin sc tid 5. docusate sodium po bid prn 6. atorvastatin 80 mg daily 7. metoprolol 12.5 mg 8. captopril 6.25 mg tid 9. aspirin 325 mg daily 10. donepezil 5 mg qhs 11. memantine 5 mg po bid 12. citalopram 10 mg daily 13. calcium carbonate 500 mg po qid 14. cholecalciferol (vitamin d3) 400 unit daily 15. senna prn 16. lansoprazole 30 mg daily 17. mvi daily 18. acetaminophen q6h prn 19. ferrous sulfate 300 mg daily 20. furosemide 30 mg daily (100 mg at discharge in ) 21. riss 22. lantus 6u qam and 35u qhs 23. bisacodyl 5 mg daily discharge medications: 1. aspirin 325 mg tablet : one (1) tablet po daily (daily). 2. albuterol 90 mcg/actuation aerosol : one (1) inhalation every four (4) hours as needed. 3. artificial tears drops : one (1) ophthalmic twice a day as needed for eye irritation. 4. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day): continue while on antibiotics. 5. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed. 6. atorvastatin 80 mg tablet : one (1) tablet po once a day. 7. metoprolol tartrate 25 mg tablet : tablet po twice a day: hold for systolic blood pressure < 90 or heart rate less than 50. 8. donepezil 5 mg tablet : one (1) tablet po at bedtime. 9. memantine 5 mg tablet : one (1) tablet po twice a day. 10. citalopram 10 mg tablet : one (1) tablet po once a day. 11. calcium carbonate 500 mg capsule : one (1) capsule po four times a day: please separate from all other medications by 1 hour. 12. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po once a day. 13. senna 8.6 mg capsule : one (1) capsule po twice a day as needed for constipation: hold for diarrhea. capsule(s) 14. docusate sodium 100 mg tablet : 1-2 tablets po twice a day as needed for constipation: hold for diarrhea. 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 16. multivitamin tablet : one (1) tablet po once a day. 17. iron 325 mg (65 mg iron) capsule, sustained release : one (1) capsule, sustained release po once a day. 18. furosemide 80 mg tablet : one (1) tablet po once a day. 19. insulin glargine 100 unit/ml solution : twenty four (24) units subcutaneous at bedtime. 20. insulin regular human 100 unit/ml solution : per sliding scale injection qachs. 21. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 22. vancomycin 250 mg capsule : one (1) capsule po q6h (every 6 hours) for 4 weeks: to complete regimen 2 weeks after meropenem finishes, last day . 23. meropenem 500 mg recon soln : one (1) recon soln intravenous q8h (every 8 hours) for 2 weeks: to complete 2 week course with last day on . 24. metronidazole 500 mg tablet : one (1) tablet po three times a day for 4 weeks: to complete course 2 weeks after meropenem finishes, last day . discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses septic shock acute renal failure complicated urinary tract infection with urosepsis c. difficile colitis hypernatremia dehydration secondary diagnoses: diabetes mellitus hypertension coronary artery disease dementia discharge condition: stable, tolerating tube feeds. discharge instructions: you were admitted with septic shock from urine infection and c. difficile colitis. you were started on antibiotics for this and will need to complete a 2 week course (meropenem) for the urine infection and a total of 4 weeks (po vancomycin and iv flagyl) for the c. difficile colitis. you received intravenous fluids for low-blood pressure and your blood pressure medications were changed from the ones that you came in on. please follow-up with your primary care physician for further adjustment of your blood pressure medications as appropriate. please contact your physician or return to the emergency room if you notice fevers, lightheadedness, or any other concerning symptoms. followup instructions: please follow-up with your primary care physician 2 weeks. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified septic shock intestinal infection due to clostridium difficile hyperosmolality and/or hypernatremia acute on chronic systolic heart failure pseudomonas infection in conditions classified elsewhere and of unspecified site 

Answer: The patient is high likely exposed to