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: meperidine attending: chief complaint: fevers/cholangitis major surgical or invasive procedure: right ij placement history of present illness: mr. is a 61 year-old man with alcoholic cirrhosis and hcc s/p oltx , multiple episodes of biliary sludge/stones requiring ercp, delayed hepatic arterial thrombosis with resultant ischemic cholangiopathy and bile lakes, who presents with fevers and abdominal pain after undergoing ercp on with extention of pre-existing sphincterotomy which was stenosed. biliary debris was expressed. there were also multiple stones in the biliary tree. he is being transferred to the from micu 7 as a precaution in case he needs emergent ercp. full hpi is available in the micu 7 admission note. briefly, he initially underwent ercp with extension of existing sphincterotomy on for jaundice and pruritis. his bili fell from 7.9 to 2.8 post-procedure. he received levo/flagyl initially but was discharged from the - service off antibiotics on the morning of admission reportedly looking well. however, when he returned home, he developed rigors, a fever of 103.5, and ruq pain, so he represented to the ed on the evening of . there, he had a fever to 105f and his sbps fell to the 80s. a cvl was placed and he was bolused 6l ns; levophed was also started. ercp was consulted and he went to micu7 because of lack of bed availability in the . in micu 7, his levophed, initially at 0.08 mcg/kg/hr was weaned and off by noon. his systolic blood pressure ranged from 97 to 121 since admission, his hr 90-115, and he has been afebrile. he was continued on zosyn and is now growing gnrs on bcx, resistant to cipro and gent, but sensitivie to cefepime, ceftaz, and ctx. his tbili which was initially going up from 2.3 to 2.9 while discharged, trended down to 2.2 this am. his lfts are trending down as well. his cr increased from nl baseline and 1.0 upon discharge to 1.5 overnight and 1.6 this am. he was given dilaudid for pain. he was seen by ercp who wanted to watch him clinically for now, and feels he likely has an area of edema causing mild obstruction versus biloma in rt lobe or retained stone fragment. hepatology saw him as well and recommended a diagnostic para. currently upon arrival, he feels much better and no longer with rigors. he reports increased le edema and abdominal distension beginning today. other than one dose at home, he has been without his diuretics since his last admission. he has continued mild ruq pain, but no other abdominal pain. review of systems: (+)ve: as per hpi (-)ve: night sweats, loss of appetite, fatigue, chest pain, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: 1. h/o etoh cirrhosis: -- c/b hcc, diuretic-resistant ascites, left hepatic hydrothorax, variceal hemorrhage s/p banding, encephalopathy, anemia -- s/p oltx -- c/b renal failure calcineurin toxicity, multiple episodes of biliary sludge & stones s/p repeat ercps (most recent ), multiple episodes of acute cellular rejection (, , ), delayed hepatic arterial thrombosis and resultant ischemic cholangiopathy and bile lakes 2. s/p roux-en-y hepaticojejunostomy at time of oltx 3. cad w/ mi s/p ptca 4. hypertension 5. dyslipidemia 6. osteoporosis 7. s/p bilateral inguinal hernia repairs 8. s/p umbilical hernia repair 9. s/p lipoma removal from left posterior neck social history: remote history of alcohol and tobacco, none for years. lives with his wife. two children. retired police officer. denies illicit drugs. family history: no family history of hereditary hemochromatosis, colon cancer or diabetes. otherwise noncontributory. physical exam: vs: 98.9 hr 96 127/64 93%2l gen: the patient is in no distress and appears comfortable skin: no rashes or skin changes noted heent: jvd 12 cm, neck supple, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. chest: mild bibasilar rales, o/w ctab no w/r. cardiac: regular rhythm; no murmurs, rubs, or gallops. abdomen: obese and distended, ttp ruq. no shifting dullness. nabs. no rebound or guarding. extremities: 2+ le pedal edema, extremities warm without cyanosis. 2+ distal pulses. neurologic: alert and appropriate. cn ii-xii grossly intact. strenght and sensation grossly intact. pertinent results: hematology: 08:10pm wbc-2.9* rbc-4.62 hgb-11.8* hct-38.2* mcv-83 mch-25.6* mchc-31.0 rdw-17.4* 08:10pm neuts-80* bands-3 lymphs-9* monos-2 eos-3 basos-0 atyps-0 metas-0 myelos-3* 08:10pm plt count-133* 08:10pm pt-12.6 ptt-23.6 inr(pt)-1.1 . chemistries: 08:10pm glucose-136* urea n-27* creat-1.0 sodium-142 potassium-4.3 chloride-103 total co2-26 anion gap-17 08:10pm alt(sgpt)-444* ast(sgot)-552* alk phos-715* tot bili-2.9* 08:10pm lipase-43 . urinalysis: 11:00pm urine color-straw appear-clear sp -1.008 11:00pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:00pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0 . imaging: cxr portable : upright ap view of the chest is obtained. low lung volumes limit evaluation. no free air is seen below the right hemidiaphragm. double density of the right hemidiaphragm is compatible with known eventration better seen on the prior ct. there is no evidence of pneumonia or chf. linear densities in the lower lungs are most compatible with atelectasis. heart size is grossly within normal limits allowing for technique. bony structures are intact. . ruq ultrasound (wet read): : stable size to right lower liver lobe bile , but with new echogenic debris. may be related to recent ercp, but infection cannot be excluded. stable bile duct dilation. normal portal vein flow. . microbiology: blood cultures x 2 : 8:20 pm blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s piperacillin/tazo----- 8 s tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r . blood cultures x 2 : ngtd at time of discharge brief hospital course: mr. is a 61 year-old man with alcoholic cirrhosis and hcc s/p oltx , multiple episodes of biliary sludge/stones requiring ercp presenting with sepsis/cholangitis. . sepsis/cholangitis/e. coli bacteremia: multiple episodes of biliary obstruction previously thought to be secondary to hepatic artery insufficiency and presenting with fevers, rising bilirubin, ruq pain after ercp on . gnrs growing in both bcx from ed with sensitivities as above, most likely source from biliary source. his hypotension responded to fluid and his levophed was weaned off with hemodynamic stabilization. he had been on zosyn initially with clinical improvement. bedside u/s shows no obvious pocket for ascites. he was evaluated by the ercp team who did not feel that repeat ercp was warrented at this time given clinical improvement. his bilirubin and lfts trended down. his bacteremia resulted to e. coli sensitive to ceftriaxone, for which he was switched to complete a 10 day total course through . a picc line was placed prior to discharge. . alcoholic cirrhosis s/p : thought to be a possible candidate for re- given complications. rapamycin dose recently reduced for supratherapeutic level. he was continued on mycophenolate and sirolimus for his immunosuppresive. he was also continued on his home ursodiol and bactrim. his lasix was initially held given hemodynamic instability but was restarted on . he will follow up closely with his hepatologist. his lasix was restarted and dose increased at discharge given edema. . acute renal failure: felt to be secondary to hypoperfusion in the setting of sepsis. he was fluid resuscitated and his antihypertensives and lasix were held. his creatinine peaked at 1.6 and trended down to 1.2. his lasix was restarted at the time of floor transfer and upon discharge. . abdominal distension and le edema: worsening abdominal distension and le edema likely related to underlying liver disease and being without his diuretics. abdominal ultrasound was performed but did not show any evidence of ascites. his diuretics were held in the setting of acute renal failure and hemodynamic instability but were felt safe to resume at the time of floor transfer and at discharge. his lasix was restarted and dose increased at discharge given edema. his discharge weight was 208 lbs. . thrombocytopenia: near baseline, cont to follow. . coronary artery disease, native: stable. held atenolol and asa initially. gemfibrozil and statin were held at last admission elevated ck and myalgias. last echo normal 7/. these medications were held at discharge . hypertension, benign: held antihypertensives initially. restarted prior to discharge . code status: full . emergency contact: ms. , home phone: work phone: medications on admission: 1. alendronate 70 mg tablet sig: one (1) tablet po qthur (every thursday). 2. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 3. furosemide 20 mg tablet sig: one (1) tablet po once a day. 4. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 5. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1)capsule, delayed release(e.c.) po hs (at bedtime). 7. ursodiol 300 mg capsule sig: two (2) capsule po qam (once a day 8. ursodiol 300 mg capsule sig: one (1) capsule po qpm (once a day (in the evening)). 9. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 10. sirolimus 1 mg tablet sig: two (2) tablet po daily (daily). 11. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 12. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po tid (3 times a day). 13. caltrate 600+d plus minerals 600-400 mg-unit tablet sig: one (1) tablet po twice a day. 14. multivitamin tablet sig: one (1) tablet po daily 15. bactrim 80-400 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 6 days. disp:*6 injections* refills:*0* 2. alendronate 70 mg tablet sig: one (1) tablet po qthur (every thursday). 3. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. ursodiol 300 mg capsule sig: two (2) capsule po qam (once a day (in the morning)). 6. ursodiol 300 mg capsule sig: one (1) capsule po qpm (once a day (in the evening)). 7. sirolimus 1 mg tablet sig: two (2) tablet po daily (daily). 8. atenolol 25 mg tablet sig: .5 tablet po once a day. 9. furosemide 20 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 10. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 12. bactrim 80-400 mg tablet sig: one (1) tablet po once a day. 13. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 14. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: home solutions discharge diagnosis: e. coli bacteremia cholangitis alcoholic cirrhosis, liver coronary artery disease, native hypertension, benign biliary sludge discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you were admitted with infection of your biliary system (cholangitis). you were very sick and spent some time in the icu. you were treated with iv antibiotics. you were found to have bacteria in the blood which was treated. you will need to complete a full course of iv antibiotics through your picc line. . please weight yourself when you get home. if your weight does not decrease over the next 2 days-or- it goes up at anytime, please call your doctor. it means your lasix dose will need to be adjusted. . please continue all previous medications as before, except for your lasix. your lasix dose was increased to 20mg 2x/day. please follow up with your pcp and hepatologist as soon as possible. you will have blood work checked on and this will be faxed to your pcp. followup instructions: appointment #1 md: dr. specialty: pcp / time: , at 11:00am location: , , phone number: . appointment #2 provider: clinic phone: date/time: 3:20 procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute kidney failure, unspecified severe sepsis percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia osteoporosis, unspecified liver replaced by transplant septicemia due to escherichia coli [e. coli] cholangitis 

Answer: The patient is high likely exposed to