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: ampicillin / penicillins / bactrim attending: chief complaint: abdominal pain major surgical or invasive procedure: medical intensive care unit stay; femoral venous central line; history of present illness: 82 yo f with history of recurrent uti's with chronic indwelling foley, cva/seizures, htn, af, who presented from nh with 2-3 days of abdominal pain. she was treated with bowel regimen for presumed constipation. she also had nausea and 2 episodes of nonbloody vomiting. in the ed she was febrile to 102.8, normotensive, and leukopenic (~2.5) with lactate elevated to 6.6. ua showed uti. ms appeared at baseline per family. no cp/sob/cough/meningeal signs. in the ed she was given vanco/levaquin/flagyl. likely urosepsis. past medical history: -tuberculosis exposure, s/p treatment with inh and rifampin -sinusitis -arthritis -bilateral cataract surgery -dementia -atrial fibrillation -htn -recurrent utis -seizure disorder in association with uti/infection -r mca stroke c residual l hemiplegia -lichen planus -nstemi in . social history: the pt. is a nursing home resident. she denied use of tobacco, alcohol, or iv drugs. from . family history: noncontributory. physical exam: vs: t 98.5 hr 85 bp 98/48 rr 20 o2sat 98% on 2l nc. fs 157 gen: awake, alert. talkative, but aphasic and difficult to understand at times. heent: perrl, eomi. mm moist. neck: no jvd heart: rrr, s1s2, no m/r/g lungs: cta anteriorly abd: +bs, soft, nt/nd. ext: 1+ nonpitting edema of b/l le way to knees; femoral line in place. neuro: l sided hemiparesis: cannot lift l arm, can wiggle toes, l moves less than r. otherwise nonfocal. pertinent results: wbc 2.6 on admission, incr to 31.1 with steroids, down to 13.5 at discharge bands 18->5 inr 3.9->5.8--> 1.4 by the time of discharge tnt peaked at 0.09-> <0.01 by discharge 08:13pm blood fibrino-455* d-dimer-3211* stim test: 09:02am blood cortsol-44.0* 09:42am blood cortsol-47.4* 10:18am blood cortsol-48.5* 11:00pm blood phenyto-6.9* cxr: impression: bibasilar atelectasis. no chf or free air. ct abd/pelvis: impression: moderate hydronephrosis and hydroureter within the collecting systems bilaterally. the bladder is distended even though a foley catheter lies within it. reassessment of the foley catheter and urine output is recommended. urine culture (final ): pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. yeast. ~3000/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 16 i ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- =>16 r meropenem------------- =>16 r piperacillin---------- =>128 r piperacillin/tazo----- =>128 r tobramycin------------ =>16 r blood cultures: aerobic bottle (final ): escherichia coli. identification and sensitivities performed from anaerobic bottle. anaerobic bottle (final ): reported by phone to hardy 1350. escherichia coli. final sensitivities. trimethoprim/sulfa sensitivity 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 cefuroxime------------ 16 i ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin---------- 32 i piperacillin/tazo----- 8 s tobramycin------------ <=1 s brief hospital course: 82 yo woman with hx of afib on coumadin, s/p cva, with recurrent uti, gnr bacteremia, and urosepsis. . 1. septic shock/urosepsis: the patient was hypotensive on admission to the icu, with sirs + lactic acidosis and hypotension not responding to ivf. a femoral line was placed in the ed given her coagulopathy (inr 3.8). sepsis protocol ws initiated, with fluid bolus prn (titrated to urine output), levophed started to keep map>65. svo2 (from groin line) falsely high at 91%. insulin drip was started to optimize glucose control in the setting of sepsis, but was stopped soon after with good glucose control. she was empirically started on vancomycin, levofloxacin and gentamicin in the icu. stimulation test returned with elevated baseline cortisol at 44, with poor response (48 at 60 minutes), and she was started on hc and fc. an infectious work-up was initiated pre-abx, remarkable for +u/a with alkalotic ph (history of proteus uti). foley was changed, with good urine outputblood cultures subsequently grew gnr 4/4 bottles (cx from ), identified at e coli, sensitive to cephalosporins and gent. gentamicin was continued for treatment and was dosed by level. cxr wihtout acute cp process. lactate improved with antibiotics. levophed was titrated off on day #3. pt was transferred to the floor on . a picc line was placed for antibiotics and the femoral line was removed. culture of the femoral line tip was negative. hydrocortisone was changed to po prednisone and tapered down. short taper will continue on discharge. fludrocort was discontinued prior to discharge. the patient was afebrile for several days prior to discharge, and her wbc count was decreasing. blood cultures remained positive until . cultures drawn on were pending at the time of discharge but had no growth to date. urine culture on grew pseudomonas which was pan-resistant, but only 10-100,000/ml so we did not treat this. if the patient is symptomatic, a ua and urine culture should be repeated at the nursing home. treatment with gentamicin will continue for 1 more week. a gentamicin peak and trough level should be checked tomorrow. * 2. cad: history of nstemi in '. ekg on admission with lateral st depressions, ruled out for mi with negative cardiac enzymes (ck rose from 50-->375, with trop <0.01 to peak 0.09, then trending down. flat ck-mb). on asa and statin. pt is not on a bb because this has aggravated her lichen planus in the past (see below). * 3. coagulopathy: on coumadin as an out-patient for atrial fibrillation, with supatherapeutic inr on admission. she received vitamin k 1 mg iv x 1 on in order to reverse her coagulopathy. platelets and fibrinogen were stable, not suggestive of dic (although fdp elevated). when inr decreased <2, a heparin drip was started for anticoagulation. coumadin was re-started prior to discharge. given history of supratherapeutic inr, pt will be discharged on 4mg coumadin rather than her home dose of alternating 5mg/6mg. * 4. afib: on diltiazem at home, which was held initially due to hypotension. bb was started given her hx of cad, but this was discontinued due to lichen planus (see above). discharged on home dose of diltiazem. on coumadin at home. anticoagulation as described above. * 5. dementia: mental status was close to her baseline per family on . patient also on dilantin for ? seizure disroder, level 6.9 on with albumin 3.1. no change made in dose. * 6. lichen planus: pt was briefly started on metoprolol given her hx of cad. however, the patient developed worsening lichen planus rash, and upon checking past dermatology notes she has a history of lichen planus being exacerbated by bb. metoprolol was stopped and home diltiazem resumed for her afib. * 7. anemia: transfused 1u prbcs for hct 27.9. hct increased to 32.9. hct was stable after that point. no evidence of hemolysis. stools were guaiac negative. hct drop likely was dilutional in the setting of large volume iv fluid resuscitation. * 8. glucose control: started on insulin gtt in the icu for optimization of glycemic control in the context of sepsis. this was stopped within 24-36h with good glycemic control after that point. fs were checked qid and pt was covered with insulin sliding scale. npo at present, ? advance on . * 9. fen: pt failed swallow eval on . however, successful bedside informal swallow evaluation was done prior to discharge. the patient had an ngt when she came to the floor from the icu, but she coughed it out prior to discharge and it was not replaced. she tolerated a regular diet with thickened liquids. she should have aspiration precautions. * 10. the patient was full code during this admission. this was also discussed with her family. medications on admission: cardizem 120 lasix 40 daily mvi dilantin 200qam/300qpm protonix 40 colace/senna tylenol prn coumadin 5mg sun/m/w/f/sat coumadin 6mg tue/th discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. dilantin 100 mg capsule sig: two (2) capsule po qam. 4. dilantin 100 mg capsule sig: three (3) capsule po at bedtime. 5. colace 100 mg capsule sig: one (1) capsule po twice a day: hold for loose stools. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for headache/fever. 7. prednisone 10 mg tablet sig: one (1) tablet po qam (once a day (in the morning)) for 2 days. 8. warfarin sodium 1 mg tablet sig: four (4) tablet po once a day: need to check inr blood test in days and adjust dose accordingly for goal inr . 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. diltiazem hcl 120 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po daily (daily). 11. vitamin c 100 mg tablet sig: one (1) tablet po once a day. 12. zinc 50 mg tablet sig: one (1) tablet po once a day. 13. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) for 2 weeks: apply to affected skin. 14. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 15. triamcinolone acetonide 0.1 % ointment sig: one (1) appl topical daily (daily). 16. gentamicin 40 mg/ml solution sig: two y (240) mg injection q24h (every 24 hours) for 7 days. discharge disposition: extended care facility: hollywell - discharge diagnosis: urinary tract infection bacteremia, e. coli, likely urosepsis atrial fibrillation coronary artery disease anemia, stable chronic foley for urinary retention history of cva discharge condition: stable, tolerating pos, baseline l-hemiparesis discharge instructions: contact md if you develop fever/chills, shortness of breath, abdominal pain, or other concerning symptoms a urine culture on grew pseudomonas which was pan-resistant, but only 10-100,000/ml so we did not treat this. if the patient is symptomatic, a ua and urine culture should be repeated at the nursing home. followup instructions: follow-up with primary care physician 2-4 weeks urine culture on grew pseudomonas which was pan-resistant, but only 10-100,000/ml so we did not treat this. if the patient is symptomatic, a ua and urine culture should be repeated at the nursing home. procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: urinary tract infection, site not specified unspecified essential hypertension severe sepsis atrial fibrillation other convulsions septic shock old myocardial infarction long-term (current) use of anticoagulants retention of urine, unspecified late effects of cerebrovascular disease, hemiplegia affecting unspecified side septicemia due to escherichia coli [e. coli] hydronephrosis infection and inflammatory reaction due to indwelling urinary catheter lichen planus 

Answer: The patient is high likely exposed to