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: penicillins attending: chief complaint: hemoptysis/tracheal bleed, hypoxia major surgical or invasive procedure: rigid bronchoscopy with debridement of granulation tissue and trach size change history of present illness: 70f with dm, asthma, chronic respiratory failure pna/asthma (? vented at night with chronic trach x ? 3 months) cva, cad, s/p recent tracheal bleed and trach change transferred from osh with recurrent tracheal bleed for ip eval and bronchoscopy. oxygen saturations 80% on 50% fio2 in ip suite so she was admitted to micu for bronchoscopy and evaluation. patient's prior bronch in revealed subglottic stenosis, granulation tissue at stoma, plaque like lesions on main carina and rigth bronchus intermedius (bx-no malignancy), polypoid lesions main carina. no evidence of tm and trach replaced with new cuffless #6 trach tube. there was ? hsv but biopsies were negative. . in ip suite, initial vs were: t97.6 p68 bp121/57 r20 o2 sat92% on 35%. patient was transferred to icu for assessment and plan for flexible bronch in afternoon and rigid bronchoscopy tomorrow. . on the floor, her only complaint is left arm pain which has been treated with neurontin. she states this "just started" but unclear when. reports "a little sob", but improved now on vent. denies further bleeding from trach site, wheezing, chest pain, cough, abdominal pain, lh, dizziness. states she had fevers and chills 6 days prior but none since then. . review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: iddm2 asthma chronic resp failure ( asthma and pna) s/p trach and peg ? 3 months ago (? on ventilator at night) s/p bronch , , cuffless trach replacement to cuffed catheter in ed cva (l weakness) cad htn djd gerd h/o afb in sputum felt to be colonizer polypoid lesion trachea ? hypothyroidism ? hyperlipidemia social history: resident at commons. has 3 sons. worked as manager of group home. - tobacco: denies - alcohol: rare - illicits: none family history: non-contributory physical exam: general: alert, intermittently falling asleep during exam, oriented to city and state, date, not month, no acute distress, able to communicate by whispering in full sentences heent: sclera anicteric, mmm with thrush, oropharynx clear neck: supple, jvp not elevated, no lad lungs: coarse breath sounds with exp wheezes bilaterally. no crackles or rhonchi cv: regular rate and rhythm, normal s1 + s2 with 2/6 systolic murmur lusb, no rubs or gallops abdomen: soft, obese, non-tender, multiple ecchymoses, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. lue with mild nonpitting edema neuro: aaox2-3 as above. cn 2-12 intact. 5/5 strength rue and /l. lue contracted with inability to uncle fist. pertinent results: 05:40pm blood wbc-13.3* rbc-3.69* hgb-10.0* hct-30.4* mcv-83 mch-27.1 mchc-32.8 rdw-16.4* plt ct-410 03:50am blood wbc-10.3 rbc-3.29* hgb-9.0* hct-28.3* mcv-86 mch-27.3 mchc-31.7 rdw-16.3* plt ct-371 05:40pm blood neuts-65 bands-0 lymphs-23 monos-4 eos-8* baso-0 atyps-0 metas-0 myelos-0 05:40pm blood pt-12.7 ptt-23.9 inr(pt)-1.1 05:40pm blood glucose-148* urean-30* creat-1.0 na-138 k-4.8 cl-95* hco3-36* angap-12 03:50am blood glucose-92 urean-26* creat-0.9 na-137 k-5.0 cl-100 hco3-27 angap-15 05:40pm blood calcium-9.3 phos-4.6* mg-2.3 04:47am blood calcium-8.7 phos-3.9 mg-2.2 01:35pm urine blood-mod nitrite-pos protein-25 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 01:35pm urine rbc-0 wbc->50 bacteri-many yeast-none epi- transe-0-2 8:36 pm urine source: catheter. **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- r ceftazidime----------- =>64 r ceftriaxone----------- r ciprofloxacin--------- =>4 r gentamicin------------ 4 s meropenem-------------<=0.25 s nitrofurantoin-------- 256 r piperacillin/tazo----- 8 s tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r , blood cx pending, ngtd cxr: low lung volumes. minimal bilateral atelectasis ct trachea: 1. extensive abnormal soft tissue thickening in the supraglottic and infraglottic regions and surrounding the tracheostomy, likely reflecting granulation tissue. severe stenosis at the level of the cricoid cartilage. the tracheostomy appears patent. 2. limited evaluation of the lungs due to respiratory motion. no large pulmonary nodules or areas of consolidation. cxr: worsening left mid lung zone opacity concerning for infection or worsening atelectasis. brief hospital course: acute hypoxemic on chronic respiratory failure - this was thought to be due to granulation tissue seen around the area of her tracheostomy and subglottic stenosis. she had a rigid bronchoscopy by ip which showed diffuse granulation tissue around her stoma and her trach, as well as subglottic stenosis. this was debrided and a larger size (#7 non-fenestrated) trach tube was inserted. she tolerated the procedure well without difficulty. the patient had hemoptysis at an osh that was initially thought to be hsv tracheitis, however biopsies were negative. the hemoptysis was thought to be due to the granulation tissue. per ip recs, started omeprazole and ranitidine. hct remained stable during admission. wbc trended down to 10.3. psv overnight, required peak 10 peep 5 overnight night of . trach mask trial successful during day. uti: patient with cloudy, foul smelling urine. u/a showed evidence of uti with many bacteria. started on cipro. on day 3 of antibiotics, culture results became available, showing klebsiella sensitive only to zosyn, gentamycin, and meropenem. patient had a picc line placed by ir as the picc team could not at bedside. she was discharged on meropenem as she had a previous reaction to zosyn. diabetes: on detemir and humalog sliding scale. hypoglycemic to 60s during afternoon and overnight, so decreased detemir from 25 to 20 . anxiety: ativan prn. yeast infection: noted white discharge and foul odor. received fluconazole 200mg x1. asthma: continued home albuterol. thrush: nystatin oral suspension. lue pain: pt reports lue pain with unclear chronicity on neurontin. be secondary to cva vs dvt, chronic neuropathic pain. continued neurontin and used oxycodone prn. cad and s/p cva: held asa for procedure. prior to discharge, asa was restarted with agreement from interventional pulmonology. hyperlipdemia: continued statin. hypothyroidism: continued levothyroxine. medications on admission: tylenol 650 q4 prn dulcolax 10mg po daily prn levothyroxine 0.1 mg po daily lexapro 20mg daily per peg ferrous sulfate 320mg po bid neurontin 300mg po tid hctz 12.5mg po daily novolog sliding scale levimere 25mg sc bid lactobacillus 1 tab po tid lorazepam 0.5mg po q6 prn milk of magnesia 30ml peg prn oxycodone ir 10 mg po q4h prn pantoprazole 40 mg iv daily seroquel 25mg po bid ropinirole 2mg peg qhs zocor 20mg peg daily ambien 5mg po qhs prn omeprazole 20mg via peg zantac 30 mg via peg qhs ventolin 2.5 mg inh q 2 hours prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain. 5. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 6. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 7. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 9. oxycodone 5 mg/5 ml solution sig: five (5) ml po q4h (every 4 hours) as needed for pain. disp:*150 ml* refills:*0* 10. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. ropinirole 1 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 12. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 13. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 14. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q2h (every 2 hours) as needed for . 15. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 16. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 17. ranitidine hcl 150 mg tablet sig: two (2) tablet po hs (at bedtime). 18. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 19. levemir 100 unit/ml solution sig: 25 units subcutaneous twice a day. disp:*50 * refills:*2* 20. novolog 100 unit/ml solution sig: asdir subcutaneous qachs: per sliding scale . 21. general care please keep the head of the bed elevated to 60 degrees at all times. 22. meropenem 1 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 7 days. disp:*21 recon soln(s)* refills:*0* 23. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: commons discharge diagnosis: hemoptysis, subglottic stenosis, granulation tissue around stoma discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear ms. , it was a pleasure taking care of you during your hospitalization. you were admitted to the hospital for bleeding coming from your tracheostomy. you underwent a rigid bronchoscopy during which you had granulation tissue removed and your trach was replaced. you tolerated this procedure and then had a trial with your trach mask which you did well with. you were found to have a urinary tract infection caused by a bacteria called klebsiella while in the hospital and we started you on a medication called meropenem which you will take for 7 days. you had a chest x-ray that was concerning for pneumonia, however you had no cough or increasing oxygen requirement that made us concerned for pneumonia at this time. you should be monitored closely for fevers and worsening respiratory status that could signal a pneumonia. medication changes: - please take nystatin oral suspension 5 ml orally four times a day as needed for thrush. - started meropenem 1000 mg iv every 8 hours for 7 days - started ranitidine 300 mg orally in the evening - started oxycodone 5mg/5ml q4h for pain - increased omeprazole to 40 mg orally twice a day - decreased acetaminophen 650 mg orally every 6 hours for pain please make sure the head of your bed is always elevated to 60 degrees. note: attempted to contact family to inform them of ms. transfer back to . tried calling listed numbers for hcp () and alternate . both numbers out of service. only other number listed in our system is for . pt states that she does not know the new phone numbers, but has them written down at home. she states that she does not mind if we do not contact her family, as she plans to call them when she returns to . contact , and neither the admissions coordinator , nor the staff on her unit were able to locate any other phone numbers. checked with case manager , who also did not have any other phone number. spoke with sw who recommended contacting pcp. listed pcp??????s office; they could not locate any records for pt. followup instructions: please follow up with ip with dr. in 2 weeks. - dr () provider: intake,one rooms/bays date/time: 7:30 provider: , md phone: date/time: 8:00 provider: room two phone: date/time: 8:00 md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy replacement of tracheostomy tube local excision or destruction of lesion or tissue of trachea diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism asthma, unspecified type, unspecified candidiasis of mouth other and unspecified hyperlipidemia anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute and chronic respiratory failure other late effects of cerebrovascular disease morbid obesity osteoarthrosis, unspecified whether generalized or localized, site unspecified hematemesis other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities unspecified hereditary and idiopathic peripheral neuropathy leukocytosis, unspecified gastrostomy status candidiasis of vulva and vagina other diseases of trachea and bronchus mechanical complication of tracheostomy muscle weakness (generalized) 

Answer: The patient is high likely exposed to