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: blood from trach major surgical or invasive procedure: bronchoscopy (bedside): small area of injury at main carina without active bleeding. blood seen in all segments and cleared fully. upon re-inspection return of blood seen and with bal progressive bloody return seen. history of present illness: hpi: ms. is an 89 yo female with pmh notable for alzheimer's disease, depression, paroxysmal afib on coumadin and recent admission to micu for mrsa pneumonia, proteus urosepsis and stenotrophomonas vap who presents from her rehab facility with bright red blood from her trach. on at 1400, the patient was noted to have blood-tinged secretions. at that time, labs were obtained and heparin was held. lasix was also increased to 40 mg iv bid. at 1500, nurse blood from trach. inr noted to be 5.4 with hct 29.1. later in the evening (2300), her nurse hemoptysis with hct down to 23.8; vent settings at that time ac 12x350, peep 5, fio2 40% with oxygen saturation 93%. cxr showed worsening bilateral infiltrates by report; she had a ct scan of the chest which showed at midnight, she was seen by the icu resident that she had been treated with 2 u ffp and 5 mg vitamin k. abg at that time demonstrated ph 7.46 / pco2 59 / po2 77. due to hemoptysis, the patient was transferred back to the icu for further evaluation and treatment. . on arrival to the ccu, the patient has blood secretions from her et tube. she opens eyes to voice and actively opposes eye opening but otherwise is nonverbal at present. past medical history: alzheimer's depression hypernatremia paroxymal afib h/o urinary tract infections cholelithiasis h/o influenza a/b social history: permanent resident of manor. chinese speaking only, son and daughter active in her life and visit daily. family history: n/a physical exam: vitals: t 98.9, hr 108, bp 171/88, rr 37, o2 100% on ac 12x400, peep 5, fio2 60% gen: lying still with eyes closed, trach in place, no distress heent: actively opposes eye opening, tongue slightly dry neck: trach in place with mild bright red ooze surrounding insertion site pulm: coarse breath sounds bilaterally, expiratory wheeze r>l cv: rrr, difficult to hear due to vent noise abd: firm, no guarding or rebound, hypoactive bowel sounds, no specific areas of palpation which elicit grimace, peg tube in place in luq with minimal surrounding erythema extr: extremities warm, 3+ pitting edema to thighs, bruise on right hand, r picc in place neuro: trached, opens eyes to sound occasionally, actively opposes eye opening and does not follow other commands pertinent results: 02:37am blood wbc-10.8# rbc-2.09* hgb-7.2* hct-20.9* mcv-100* mch-34.6* mchc-34.6 rdw-18.2* plt ct-271 03:54pm blood hct-25.4* 04:00am blood wbc-8.9 rbc-2.49* hgb-8.1* hct-23.5* mcv-94 mch-32.3* mchc-34.3 rdw-19.5* plt ct-228 10:53am blood hct-22.8* 10:53am blood hct-22.8* 10:00pm blood hct-25.4* 03:32am blood wbc-8.7 rbc-2.65* hgb-8.5* hct-24.0* mcv-91 mch-32.0 mchc-35.4* rdw-18.4* plt ct-207 03:32am blood wbc-8.7 rbc-2.65* hgb-8.5* hct-24.0* mcv-91 mch-32.0 mchc-35.4* rdw-18.4* plt ct-207 03:34am blood wbc-13.5* rbc-2.80* hgb-9.0* hct-26.6* mcv-95 mch-32.0 mchc-33.7 rdw-18.3* plt ct-280 03:56am blood wbc-11.6* rbc-2.28* hgb-7.5* hct-21.6* mcv-95 mch-33.1* mchc-35.0 rdw-18.1* plt ct-249 05:23am blood hct-20.7* 03:19pm blood wbc-11.0 rbc-2.83* hgb-9.1* hct-25.4* mcv-90 mch-32.0 mchc-35.7* rdw-18.7* plt ct-198 03:35am blood wbc-11.8* rbc-3.38* hgb-10.5* hct-30.4* mcv-90 mch-31.0 mchc-34.5 rdw-17.4* plt ct-192 02:37am blood neuts-91.5* lymphs-2.6* monos-4.2 eos-1.5 baso-0.2 02:37am blood pt-23.6* ptt-41.5* inr(pt)-2.3* 03:54pm blood pt-16.7* inr(pt)-1.5* 04:00am blood pt-16.1* ptt-34.5 inr(pt)-1.4* 03:32am blood pt-20.9* ptt-35.8* inr(pt)-2.0* 03:34am blood pt-25.3* ptt-32.2 inr(pt)-2.5* 03:56am blood pt-16.4* ptt-28.8 inr(pt)-1.5* 03:54am blood pt-15.5* ptt-30.1 inr(pt)-1.4* 03:35am blood pt-16.5* ptt-28.4 inr(pt)-1.5* 05:23am blood ret aut-2.4 02:37am blood glucose-161* urean-32* creat-1.4* na-134 k-4.6 cl-90* hco3-40* angap-9 04:00am blood glucose-76 urean-34* creat-1.4* na-136 k-4.8 cl-91* hco3-39* angap-11 03:34am blood glucose-132* urean-38* creat-1.9* na-134 k-5.0 cl-89* hco3-42* angap-8 03:56am blood glucose-71 urean-43* creat-2.0* na-134 k-4.6 cl-90* hco3-38* angap-11 03:35am blood glucose-120* urean-44* creat-1.8* na-137 k-4.0 cl-93* hco3-38* angap-10 06:55pm blood glucose-133* urean-44* creat-1.7* na-140 k-4.2 cl-97 hco3-40* angap-7* 02:37am blood alt-18 ast-25 ld(ldh)-209 alkphos-88 totbili-0.2 02:37am blood lipase-54 02:37am blood albumin-2.6* calcium-8.5 phos-4.0# mg-2.5 03:56am blood hapto-142 03:54pm blood anca-negative b 06:29pm blood vanco-15.0 06:06pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-sm urobiln-neg ph-5.0 leuks-mod 06:06pm urine rbc-21-50* wbc-* bacteri-mod yeast-none epi-0-2 renalep-1 06:06pm urine color-yellow appear-hazy sp -1.017 06:06pm urine casthy-<1 03:02pm urine eos-positive 10:27am urine hours-random urean-440 creat-64 na-18 cl-less than uric ac-23.9 10:27am urine osmolal-336 . micro data: 3:56 am bronchial washings **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): ~/ml oropharyngeal flora. . 9:57 pm catheter tip-iv source: r arm picc. **final report ** wound culture (final ): no significant growth. . 2:51 pm stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . radiographic studies: cxr: impression: 1. developing right upper lobe infiltrate. 2. continued bilateral pleural effusions with bibasilar atelectasis. 3. findings concerning for mild congestive failure. . ct: impression: 1. migration of gastric tube into the rectus sheath. there is a clear connection, however, into the stomach and no evidence for free air or free fluid. repositioning of tube is recommended. 2. no radiographic explanation for falling hematocrit. 3. multiple incidental findings including right staghorn calculus, porcelain gallbladder, anasarca, bilateral pleural effusions with associated atelectasis, and severe atherosclerotic disease. . cxr: compared to the study from the prior day, there is increased vascular congestion and increased volume loss in both lower s. an underlying infectious infiltrate cannot be excluded. diffuse alveolar opacities are again seen. . brief hospital course: a/p: 89 yo with pmh of alzheimer's dementia, hypernatremia, uti presents with ams, sepsis physiology, uti, and impressive hypernatremia. . # blood from trach: seems from clinical history provided by rehab that patient's secretions initially were "blood tinged" and progressed to frankly blood over the course of the day on . her hematocrit in the same time period has decreased from 29-->23.8. bronchoscopy on arrival to the icu demonstrated bloody secretions which did not clear but became progressively bloodier making diffuse alveolar hemorrhage most likely diagnosis. however, could also represent lesion near trach insertion but this is less likely given bronch findings. was given 2u prbc x1 at initial presentation. held aspirin and coumadin, reversed inr with ffp, vitamin k po, and then vitamin k iv for refractory elevated inr. once inr reversed trach oozing stoped. anca negative, anti-gbm negative. . # anemia: hct drop x3 since admission. transfused 3x with 2u of blood. initial drop explained by dah. hct did not bump appropriately, found to have melena x1 and repeatedly giauac pos stool. melena explained by the peg gastric wall erosion. hemolysis labs negative. enlarging hematoma in l arm, axilla, and anterior chest, but likely source of hct drop. ct showed no intraperitoneal or retroperitoneal hemorrhage. hct has been stable as of . . # respiratory failure: initial decompensation likely due to diffuse alveolar hemorrhage, although contribution of underlying pneumonia, fluid overload, and baseline disease (?) likely contribute. of note, during prior admission patient was unsuccessfully extubated twice and could not be weaned off the vent after several attempts due to high risbis and acidemia. the patient continued to be ventilator dependent at her rehab facility and has failed trach mask and low pressure support ventilation during this admission b/c of very low tidal volumes (down to 130??????s) which improved after pressure support was increased from 10 to 20. patient??????s air movement also did improve after albuterol nebulizer treatment as per nursing staff. lasix boluses initially attempted without much improvement in uop and stopped because of rising cr. stenotrophomonis pneumonia treatment course completed. 3+gnr in sputum stain, sputum culture growing ceftriaxone-sensitive e.coli. ecoli also isolated for peg site culture and urine culture. her antibiotic regimen was adjusted. lasix drip was again attempted later in the hospital course with good response in urine output but not significant improvement in respiratory status. lasix converted to iv 60mg tid. cr and fluid status should continue to be monitored. . # acute renal failure: likely related to volume depletion secondary to blood loss and up titration of lasix at rehab and in micu as creatinine has trended up over the past week per their records higher bicarbonate level and feurea of 34% would support volume depletion as well. ua w/few eos, rare hyaline casts reported. did have hematuria, but difficult to interpret in setting of indwelling foley, elevated inr. on urine culture grew ceftriaxone-sensitive e.coli and antibiotic regimen was adjusted to cover. last day of ceftriaxone treatment should be . could also represent component of systemic process if dah associated with goodpasture's or wegener's (however anti-gbm negative). staghorn r kidney stone noted on ct could be contributing. urine has been progressively more clear and her urine output has improved on lasix drip. with improved urine output, lasix drip was stopped and she was started on lasix po 60mg tid. . #uti: ecoli with same sensitivity profile as the peg swab culture and sputum isolated in urine. treatment with ceftriaxone as above. vre colonized in urine as well. . # peg complications: erythema/ pus around peg likely combination of dermatitis/skin breakdown from pressure of peg on skin w/some cellulitic component. initially improved after 3 days on vanco and after padded bandage placed between peg and skin but has worsened over last 48 hours with increasingly purulent exudate around the tube. patient also with erosion of gastric wall around peg site. endoscopy by ip showed that peg balloon still in stomach, was re-positioned to decrease pressure on wall to better allow for healing. no free intraperitoneal air was noted on ct. repeat egd showed dobbhoff still post pyloric. erosion around peg greatly improved. peg ballon in place. no stiches needed. cultures of discharge shown to be e.coli, also sensitive to ceftriaxone. vanco was continued to treat cellulitis- last day for 10 day course. as per ip recommendations, peg to low intermittent suction. ct confirmed peg placement, dobhoff placement and r/o free air (final read pending). per ip peg tip is 2cm from stomach wall and should not be moved for 3 weeks. tube feeds were restarted via peg and well-tolerated. . # paroxysmal afib: the patient was recently started on coumadin at the rehab facility with inr now > 5 on coumadin 5 mg daily. chads-2 score by my calculation only 1 due to age-not clear that patient has h/o hypertension or chf and no documented h/o stroke or dm. aspirin and coumadin were held. she has not been on anti-arrhythmic medications and maintained a good heart rate. futher anticoagulation should be avoided . # abdominal distension: nttp. has been intermittently present since admission. usually resolves with bowel movement. lfts and lipase normal. ct w/peg findings discussed above and porcelain gallbladder, but no evidence of intraperitoneal bleed or other intraabdominal process. further work up of porcelian gallbladder as outpatient as this is often associated with adenocarcinoma. . # recent stenotrophomonas vap: treated with bactrim 250 mg iv q8h, stop date 12/5 per prior d/c summary. . # alzheimer's: cont home meds when using peg tube. during admission pt mouths words but will not follow commands. pt non-english speaking. . # ppx: ppi, heparin sq& pneumoboots, bowel regimen prn . # fen: tf via peg. . # code: dnr/dni, confirmed with son who is hcp . # access: right-sided picc (placed at during previous admission) . # communication: with patient and son ( cell . # dispo: icu level care given vent requirement medications on admission: meds: coumadin 5 mg daily bactrim 250 mg iv q8h (until ) lasix 40 mg iv qam, 20 mg iv qnoon, 40 mg iv qpm dulcolax 10 mg po daily miralax 17 g daily chlorhexidine mouth wash colace 100 mg ranitidine 150 mg daily xopenex nebs q4h and q2h prn atrovent nebs q4h & q2h prn neutraphos 1 cap 4x/day x 3 days k-phos 1 packet q6h x 3 days vitamin k 5 mg po x 1 aricept 10 mg daily memantine 10 mg vitamin e 800 u daily hep sc tid lactulose 15 ml po daily asa 325 mg po daily miconazole powder prn caltrate with vit d 600 u po bid discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 2. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 3. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours). 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. docusate sodium 50 mg/5 ml liquid : two (2) po bid (2 times a day) as needed. 6. polyethylene glycol 3350 100 % powder : seventeen (17) g po daily (daily) as needed. 7. albuterol 90 mcg/actuation aerosol : 2-4 puffs inhalation q4h (every 4 hours) as needed for wheezing. 8. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed. 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 10. heparin (porcine) 5,000 unit/ml solution : one (1) 5000 unit dose injection tid (3 times a day). 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. metoclopramide 5 mg iv q6h:prn 13. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 14. ceftriaxone 1 g iv q24h day 1 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 16. furosemide 60 mg iv q8h 17. insulin lispro 100 unit/ml solution : 2-10 units subcutaneous asdir (as directed): per humalog isulin sliding scale. discharge disposition: extended care facility: northeast - discharge diagnosis: diffuse aveolar hemmorrhage acute on chronic respiratory failure acute renal failure gastric erosion secondary to peg tube ecoli pneumonia ecoli uti abdominal cellulitis end stage dementia anemia paroxysmal atrial fibrillation discharge condition: stable, vent dependent. discharge instructions: you were admitted to the hospital for bleeding from your tracheotomy tube. you were found to have diffuse injury termed diffuse aveolar hemmorhage. the bleeding in your s was stoped with reversing your coumadin. you were given blood for your anemia. we have not been able to wean you off the ventilator. . you had acute renal failure from overdiuresis and blood loss. it has gradually improved. we are now trying to take fluid off with diuretics. . you peg tube was found to be eroding through your stomach wall. the tube was repositioned and the erossion has improved. tube feeds were resumed. . you were found to have e. coli present in your , over the peg, and in the urine. you are being treated with antibiotics for the infection. . the following pertinent changes were made to your medications. coumadin was stoped. bactrim course was completed you were started on ceftriaxone . please follow up with your doctor as detailed below . if you develop presistant fever, return of bloody secretions from your , abdominal pain or return of pus from around the peg site, dirrhea, please seek urgent medical attention. followup instructions: please call your pcp for follow up within 1-2 weeks after discharge from rehab. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of packed cells transfusion of other serum diagnoses: abnormal coagulation profile cellulitis and abscess of trunk urinary tract infection, site not specified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation depressive disorder, not elsewhere classified acute and chronic respiratory failure pressure ulcer, other site other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants pneumonia due to escherichia coli [e. coli] anticoagulants causing adverse effects in therapeutic use alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia ventilator associated pneumonia calculus of kidney tracheostomy status infection of gastrostomy mechanical complication of gastrostomy pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to