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: amoxicillin / penicillins / coumadin / oxycodone / megestrol acetate / remeron / ritalin attending: chief complaint: 87 yo man with history of prostate cancer s/p xrt, dementia, prior bladder rupture, who was treated in the micu for a new bladder rupture and urosepsis, transfered to sirs 2 primarily for management of resolving urosepsis, peritonitis, post-surgical pain, and delirium. major surgical or invasive procedure: anterior bladder perforation closure, placement of suprapubic catheter and peritoneal drain history of present illness: 87 yo man with history of prostate ca in s/p xrt, prior bladder rupture, indwelling foley, multiple utis, and recently dx dementia who presented to ed from nh with weeks of lower abdominal pain and groin pain. bright red hematuria was seen at his nursing home. his foley was changed 1 week prior to admission with sm amount of blood that cleared at the time. he was unable to give other ros. his family reported that the pt had been having abd pain and hematuria all week since foley change, and he was brought to the ed because he was having fevers, nausea/vomiting and worsening pain. prior to this past week, he had been at his best recent baseline (w/a h/o one year of new onset dementia), totally recovered from prior stroke, working with pt, alert and oriented although. after he presentated to ed he had n/v and one episode of abd pain. he triggered for tachycardia with hr 130s while vomiting. his abdomen was soft on exam. he had gross hematuria noted and urology was consulted. in line with their recs a ct with iv contrast was ordered which showed the foley catheter balloon dilated in urethra, urology came and replaced the foley. the pt started to become hypotensive, with a lowest bp to 65/30, and he received approximately 2-3l liters ivf with minimal response. he had a rij line placed, and he was started on norepinephrine. his labs were notable for lactate 2.4, wbc 7.7 with 15% bands. his ua was positive with gram negative rods. he was thus started on cefepime/gent/vanc. the pt then had ct cystogram after foley replacement prior to transfer to , notable for bladder rupture, this was believed to have occured sometime in the past week either immediately or some time after foley replacement. urology saw the patient again, at which point his abdomen was noted to be diffusely tender but not hard. his bp was noted to be 100-120s while he was being weaned off norepinephrine. after the pt was appropriately stabilized, he was taken on to the or for repair of his bladder rupture and placement of a suprapubic catheter. post-op the pt was hemodynamically stable and c/o abdominal pain. as the pt recovered from his sepsis w/ iv abx and iv ns his serial cxrs showed worsening pulmonary edema, which improved with diuresis with iv lasix. his sbp values also went up to the 200s, at which point his home htn regimen was restarted. he also became delirious soon after surgery, likely due to resolving urosepsis, pain, and pain medications. he was transfered to the medical team for management of his resolving urosepsis, post-op pain management, and delirium. past medical history: - dm ii, on insulin - prostate ca s/p xrt. diagnosed in . - chronic urinary incontinence, s/p turp . - history of uti's, including prior mrsa and pseudomonas growth. (has chronic indwelling foley, changed q6 weeks, on ppx with cephalexin per dr. - s/p bladder rupture and repair - a fib, not anticoagulated due to bleeding history. - hyperthyroidism. - depression. - hypertension. - pvd. - h/o cva - severe chronic axonal neuropathy, radiculopathy and plexopathy (due to xrt) per dr. , with right foot drop for many years. bed ridden. - l3 compression fracture. - cataract s/p bilateral laser surgery, also with "macular edema" s/p dexamethasone injxn. - hard of hearing - l thyroid nodule, benign. social history: resident. smoked 2ppd tobacco x 24 years. quit in . denies etoh. former wwii vet. former fire fighter. wife is hcp. daughter is rn, son is engineer. family history: no illnesses, strokes, dm or early heart attacks run in the family. physical exam: vitals: t:96.5 bp:132/68 p:103 (af) r: 30 sao2: 94% ra cvp 8 general: awake, responds to command, marked speech latency, minimal response to questions. appears frail, uncomfortable and fatigued. heent: pale sclera. mm dry. neck: supple, no lad. r cvl ij in place. pulmonary: lungs cta bilaterally, no wheezes, ronchi or rales cardiac: tachycardic, irregular, 2/6 systolic murmur abdomen: bs present. abd soft. diffusely tender w/tap tenderness throughout but w/o rebound or guarding. extremities: mild dependent edema in ues and , cool toes with evidence of pvd/dry gangrene of right 2nd/3rd toes. upper extremitites well perfused. foley in place, draining clear urine. skin: no ulcers noted. scattered excoriated lesions on right lower quadrant/groin area. neurologic:awake, responds to commands, can give coherent answers. oriented to person and hospital, not to specific hospital, or year, marked speech latency. eomi. slight right facial droop and ue contracture, resolves with effort. moving all extremities, grip strength equal. pertinent results: labs admission labs 03:46pm blood wbc-7.4 rbc-3.92* hgb-11.6*# hct-34.9*# mcv-89 mch-29.5 mchc-33.1 rdw-16.1* plt ct-302 03:46pm blood pt-13.7* ptt-25.1 inr(pt)-1.2* 03:46pm blood glucose-124* urean-28* creat-0.9 na-139 k-4.9 cl-107 hco3-21* angap-16 03:46pm blood albumin-3.3* 01:31am blood calcium-7.7* phos-3.2 mg-1.5* 05:39am blood type-art po2-70* pco2-30* ph-7.37 caltco2-18* base xs--6 03:47pm blood glucose-120* lactate-2.4* na-141 k-4.6 cl-105 calhco3-22 discharge labs: 06:04am blood wbc-11.2* rbc-3.34* hgb-10.2* hct-30.6* mcv-92 mch-30.5 mchc-33.2 rdw-16.2* plt ct-331 06:04am blood glucose-133* urean-26* creat-1.2 na-139 k-4.2 cl-108 hco3-24 angap-11 06:04am blood calcium-7.3* phos-2.3* mg-2.2 06:04am blood genta-5.8 microbiology: 10:25 am urine. urine culture (final ): no growth. 12:00 pm peritoneal fluid **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. reported by phone to , @ 1822 on . fluid culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. pseudomonas aeruginosa. rare growth. dr. # requested sensitivities . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem------------- 0.5 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s anaerobic culture (final ): no anaerobes isolated. 3:46 pm blood culture final report ** blood culture, routine (final ):no growth. 3:46 pm urine from catheter final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed fecal flora. clinical significance of isolate(s) uncertain. interpret with caution. gram negative rod(s). >100,000 organisms/ml.. . imaging studies: ct abdomen/pelvis w/ contrast () 1. pyelonephritis of the left kidney. no abscess. 2. the foley catheter balloon is inflated in the penile urethra. small amount of gas within the bladder and the left distal ureter are most likely related to the catheterization. 3. small amount of free fluid is noted within the pelvis. ct abdomen/pelvis w/ contrast () impressions: 1. small, 3.6 x 1.2 x 4 cm fluid collection at the posterior-superior aspect of the bladder dome, with an enhancing rim, concerning for abscess. the right pelvic catheter does not terminate within this collection. 2. trace residual free fluid in the mesentery of the pelvis. interval resolution of free contrast material in the pelvis. cxr () the ng tube tip is in the stomach. the right internal jugular line tip is at mid svc. there is interval improvement up to almost complete resolution of pulmonary edema. the left retrocardiac opacity is still present, most likely consistent with left lower lobe atelectasis. pleural effusion, bilateral, is small, left more than right. brief hospital course: 87 yo man with history of prostate cancer s/p xrt, prior bladder rupture, and dementia who was treated in the micu for a second bladder rupture, bladder rupture repair and suprapubic catheter placement, uti, sepsis, and peritonitis who was transfered to the medicine service for management of his post-surgical pain, resolving peritonitis, delirium, and heart rate control. . # bladder rupture, urosepsis, peritonitis . the pt had a history of bladder rupture s/p repair in and presented to this admission with evidence of new rupture on ct in setting of vague abdominal pain, nausea, vomiting and evolving shock. he likely has friable bladder tissue in setting of xrt for prostate ca and prior rupture. at admission it was unclear how long the rupture had been present, but may have been related temporally to recent foley catheter change one week prior. he had a history of mrsa, proteus, klebsiella and pseudomonas utis, and thus was started on broad spectrum antibiotics (vancomycin, cefepime, and gentamicin) at admission. . he was bolused with iv fluids overnight in the micu and went to the or on the first hospital day. in the or, a perforation in the anterior bladder wall was closed. a suprapubic catheter was placed in a posterior bladder wall perforation, and a jp drain was placed in the peritoneum. cultures were taken from the peritoneal fluid and urine that grew out pseudomonas sensitive to cefepime and gent, resistent to cipro. after the surgery, the output from the jp drain continued to decrease. chemical analysis was consistent with serum, rather than urine, and on the basis of this it was felt that the bladder perforations were successfully sealed. post-operatively, he was treated with iv morphine and acetaminophen for pain control. he was transfused 2 units prbcs for hematocrit 27, with appropriate bump. the pt did go on to c/o some post-surgical pain. he continued to drain clear urine from both the urethral and suprapubic catheters. he had a ct scan on to assess for a fluid collection or abscess in the pelvic cavity, which showed a small fluid collection that requires follow up ct. thus he was cleared for the removal of his jp drain. his surgical incision remained clean, dry, and intact. he had two negative urine cx. the cx of his peritoneal fluid sample taken on showed no growth except for rare pseudomonas aeruginosa growth that were shown on to be sensitive to cefepim and vancomycin. he was continued on his regimen of iv cefepim, vancomycin, and gentamycin for 10 days to ensure adequate tx of his uti and peritonitis, but was switched to solely cefepim coverage on when the culture sensitivities returns. he had a picc line placed on for the completion of his 14 day course of cefepime. he did have mild urine leakage around his suprapubic catheter, but this only lasted 3 days and urology was not concerned given that his catheters both continued to drain clear urine. he is scheduled for a f/u pelvic ct scan to reasscess the region concerning for a possible abscess, and he is also scheduled for a f/u visit with his urologist dr. for in 2 weeks. . # delirium w/r/t the pt's mental status, after his surgery, he became increasingly agitated and disoriented. the delirium was felt to be secondary to pain, recent surgery, infection, and narcotics in the setting of baseline dementia. the pt. had been receiving iv dilaudid for pain. overall the narcotics were used sparingly and his infection was treated with broad spectrum abx. zyprexa was used in small doses for acute agitation with adequate sedation. he was placed in soft restraints to protect against the pt pulling out his ngt or either of his catheters or drains. was the last time that the pt received zyprexa for agitation/delirium, and he became alert and oriented to person, hospital name, and month/year since and has been at his baseline since then (he has some known dementia). he is alert and oriented x3 on d/c. . # anemia w/r/t the pt's anemia as above, he received 2 units prbcs post-operatively for hematocrit of 27. his blood count then stabilized and he did not require further transfusions. his hemolytic work-up was negative. he stabilized in the low 30s throughout his stay and has been stable. . # atrial fibrillation the pt has a h/o atrial fibrillation controlled only by metoprolol and has not been anticoagulated due to his h/o hemorrhage on coumadin. while in the hospital he had multiple episodes of atrial fibrillation with rvr to 130-160s, typically related to pain and stress. his metoprolol had been held due to hypotension at admission, but was restarted to manage his rvr when his blood pressure tolerated. he continued to have such episodes of afib with rvr throughout his stay, and thus his metoprolol dose was increased to 50 mg q 8h up from 25 mg , which his bp tolerated. with this increase in the metoprolol maintained an average hr in the 70s and stopped having episodes of rvr. he will need outpt f/u to assess any need to adjust this regimen. . # diabetes mellitus ii: the pt was placed on a humalog sliding scale with 15u nph in the am, however was taken off of the nph due to hypoglycemia in the micu. on the floor, the pt developed hyperglycemia to the 200's and was consistently over 180, at which point 4 was added and his sliding scale was increased to maintain better glycemic control. he subsequently had lower blood glucose levels overall, but still has some levels in the 200s and now that he is not infected and will be having decreasing levels of pain and stress, his insulin regimen will likely need to be adjusted at the rehab facility with finger sticks and his primary care should f/u on this as well. . # volume status/blood pressure the pt has a h/o hypertension controlled on amlodipine and metoprolol, but he was hypotensive at admission, at whcih point he was hydrated aggressively with iv normal saline overnight and post-operatively. as he recovered from hypotension and sepsis, his blood pressure came up. serial cxrs showed worsening pulmonary edema and he was diuresed with boluses of iv lasix, which completely cleared his pulmonary edema. his outpatient antihypertensives (except for lisinopril) were restarted as tolerated after he had recovered from peritonitis and urosepsis. lisinopril should be restarted as an outpatient as tolerated by his blood pressure with the new adjustment to the metoprolol levels. . # nutrition: w/r/t the pt's nutrition, given the pt's delirium, an ngt was placed for tube feeds which were given continuously. he had a speech and swallow consult with a swallow study and was noted to be silently aspirating and was thus deemed unable to take pos until he has rehab and a further evaluation. ngtube and peg were both considered, and it was decided to plan for discharge with the ng tube with plans for speech and with a goal of reachieving ability to take pos. for now he has a feed rate of 40ml/hr but his goal is 60ml/hr. the rate was slowed given recent ngt residuals, but he is on metoclopramide and and has recently begun a bowel regimen to ensure that there is no backup causing these residuals. instrucitons are to hold for residuals over 150ml. . # scrotal edema and candidal infection the pt also experienced extreme scrotal edema for being given about 14 liters of iv fluid for his urospesis/hypotension. his scrotum was elevated to decrease the edema, and has decreased but is still an issue. he also developed a erythematous rash around his scrotum and groin area which was treated with 2% miconazole powder. there is no warmth in this area or any appearance of cellulitis. the plan is to continue to manage with miconazole powder. . # depression: the pt has a h/o depression and had been on 10mg lexapro per night prior to admission. his home dose of lexapro was held during this admission given his delirium with the plan to restart it as an outpatient. . the pt was known to be a full code status. . signed: (sub-intern) pager number , (resident) , (attending) medications on admission: cephalexin daily uti ppx nph 15 units qam riss heparin sc tid azo cranberry 450mg daily bisoprolol 5mg daily norvasc 5mg daily aspirin 81mg daily florastor 250mg tylenol 500mg tid mvi lisinopril 5mg daily simvastatin 10mg qhs prilosec 20mg daily lexapro 20mg daily mom prn constipation bisacodyl prn constipation fleet's enema prn constipation discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours) as needed for pain/fever for 3 weeks. 3. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). disp:*1 appl* refills:*2* 4. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for bladder pain. disp:*1 tablet(s)* refills:*0* 5. ondansetron 4 mg iv q8h:prn nausea, vomiting 6. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. disp:*1 tablet(s)* refills:*0* 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q 8h (every 8 hours). disp:*1 tablet(s)* refills:*2* 8. docusate sodium 50 mg/5 ml liquid sig: one (1) po daily (daily). disp:*1 50 mg/5 ml* refills:*2* 9. insulin glargine 100 unit/ml solution sig: four (4) units subcutaneous at bedtime. 10. cefepime 2 gram recon soln sig: two (2) g intravenous twice a day for 5 days. 11. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 12. metoclopramide 5 mg tablet sig: one (1) tablet po every six (6) hours. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: your primary diagnoses include: bladder rupture peritonitis urinary tract infection sepsis secondary diagnoses delirium diabetes mellitus atrial fibrillation with episodes of rapid ventricular rate discharge condition: stable. afebrile. at his baseline mental status. pain adequately controlled on standing tylenol. discharge instructions: you were admitted to the hospital for treatment of bladder rupture and infection. you underwent surgery to repair the leak in the bladder. afterwards, you were treated with intravenous antibiotics for infection in the space around the bladder. there have been changes to your medications as follows: 1. metoprolol increased to 50 mg q 8h. this level may need to be decreased in the future as recommended at followup with your primary care doctor given you heart rate in the future. scheduled appointments: please return to the clinical center on for your scheduled follow-up ct scan of the pelvis. plan for returning to the for a followup appointment with your urologist, dr. on monday at 3 pm. the location of this appointment will be at the building surgical specialities. please call the phone number: ( with quesitons about this appointment. please call your doctor or return to the emergency room for fever > 101 deg f, worsening abdominal or bladder pain, or other new symptoms concerning to you. followup instructions: newly-scheduled follow-ups: - f/u ct 1 week after discharge to re-assess for abscess. ct scheduled for at 8:15 am at , . - f/u urology appointment: , md phone: date/time: 3:00pm. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified arterial catheterization suture of laceration of bladder percutaneous cystostomy diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis atrial fibrillation personal history of malignant neoplasm of prostate depressive disorder, not elsewhere classified accidental puncture or laceration during a procedure, not elsewhere classified mononeuritis of lower limb, unspecified long-term (current) use of insulin septic shock pressure ulcer, lower back gross hematuria pressure ulcer, heel pulmonary congestion and hypostasis other specified antibiotics causing adverse effects in therapeutic use late effect of radiation candidiasis of skin and nails pressure ulcer, stage i pressure ulcer, stage ii other suppurative peritonitis septicemia due to pseudomonas edema of male genital organs rupture of bladder, nontraumatic 

Answer: The patient is high likely exposed to