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: ureteral stricture major surgical or invasive procedure: exploratory laparotomy with intraoperative ultrasound of transplanted kidney and ureteropyelostomy of left ureter to transplanted kidney kidney needle bx history of present illness: the patient is a 68 year old hispanic male with end-stage renal disease who underwent a transplant several months ago that has been complicated by a persistent ureteral stricture. despite multiple attempts at dilation, this has been unsalvageable and recently access across the stricture was lost during manipulation. he presents for definitive repair. past medical history: past medical history: 1.diabetes mellitus type 2 times for 32 years associated with retinopathy, nephropathy and neuropathy. 2.end-stage renal disease s/p ckt with lue fistula 3. hypertension, 4. cad s/p cabg ' 5. pvd s/p r femoral distal bypass and rbka hypercholesterolemia 6. r hip orif . past surgical history: 1.status post right open reduction, internal fixation hip . 2.crt , evacuation of the hematoma , nephrostomy tube for urinoma 3. status post coronary artery bypass graft in .\ 4. right femoral-distal bypass 5. status post right below the knee amputation. 6. left upper extremity atrioventricular fistula. social history: significant for distant use of tobacco. the patient quit in . there is no history of alcohol use or drug use. his wife has cancer. he has six children, all adults with the eldest son with a history of diabetes. he has a supportive family in the area. currently lives alone at home with daughters visiting frequently. family history: noncontributory. physical exam: at time of discharge from hospital admission on physical exam: tc=97.5 p=61 bp=106/58 rr=20 100% on ra 200 cc urine, 300 cc soft stool gen - aox3, easily arousable, answers questions appropriately heent - perla, anicteric, atraumatic, normocephalic, dry mm heart - rrr, no m/r/g lungs - ctab abdomen - nt, nd, + bs, nephrostomy tube in place that is capped, no cvat ext - r bka, lle with old heel ulcer, +1 d. pedis, skin tenting pertinent results: 09:14am hgb-9.9* calchct-30 09:14am glucose-109* k+-4.9 01:31pm freeca-.94* 01:31pm glucose-142* lactate-0.9 na+-144 k+-5.0 cl--117* 01:31pm type-art po2-242* pco2-40 ph-7.28* total co2-20* base xs--7 03:24pm fibrinoge-373# 03:24pm pt-14.0* ptt-24.5 inr(pt)-1.3 03:24pm plt count-330 05:25pm wbc-4.1 rbc-3.20* hgb-8.9* hct-28.6* mcv-90 mch-27.8 mchc-31.0 rdw-16.0* 05:25pm glucose-180* urea n-32* creat-2.1* sodium-144 potassium-6.2* chloride-113* total co2-19* anion gap-18 06:00am blood wbc-6.5 rbc-3.86* hgb-10.8* hct-34.3* mcv-89 mch-28.1 mchc-31.6 rdw-15.4 plt ct-313 06:00am blood plt ct-313 06:00am blood glucose-116* urean-33* creat-2.2* na-134 k-5.8* cl-104 hco3-23 angap-13 06:00am blood alt-6 ast-24 alkphos-183* totbili-0.4 06:00am blood albumin-2.0* calcium-7.8* phos-4.6* mg-1.6 06:00am blood fk506-pnd 06:00am blood fk506-6.9 05:30am ascites creat-52.2 05:30am other body fluid creat-2.2 renal us - new blunting of the arterial waveforms without diastolic flow demonstrated. persistently elevated resistive indices ranging from 0.87 to 0.91 (previously 0.86 to 1.0). 2. moderate hydronephrosis, probably mildly increased in the interval, with questionable residual echogenic clot in the collecting system. nephrostomy catheter drainage exam - patency of ureteroureteral anastomotic site demonstrated, with free passage of contrast and no leakage. 2. exchange of existing nephrostomy for a nephroureterostomy tube (40 cm 8-french biliary tube ) echo - lvef >55% renal us - persistent moderate hydronephrosis with some debris in the collecting system. we question whether the drainage catheter is functioning. 2. minimal diastolic arterial flow to the transplant, with resistive indices near 1.0 mr without contrast - no recent infarct is identified. renal us - persistent moderate hydronephrosis with clot again visualized within the collecting system. 2. minimal diastolic arterial flow to the transplant, unchanged from . 11/12,18,25 ct head - no evidence of acute intracranial hemorrhage. please note that mri with diffusion weighting is more sensitive for the detection of acute ischemia. ct abd - there is a transplanted kidney within the right lower quadrant. this appears to be enlarged in size, and there is marked hydronephrosis, with a small amount of high density material within the lumen of the renal pelvis, consistent with focal hemorrhage. this is likely not new in comparison to recent renal ultrasounds. additionally, there is adjacent inflammatory stranding, with a focal confluence which contains several foci of gas, consistent with early, nonorganized, inflammatory change. there is associated compression of the distal right native ureter, with right hydroureter and hydronephrosis of the right native kidney. 2. cholelithiasis. 3. there is mild thickening of the descending colon and of the rectum. these loops are not fluid filled, and these may represent early colitis - clinical correlation is recommended. kidney needle bx - there is no evidence of acute cellular rejection in this sample. there is no evidence of fungal involvement (neutrophilic infiltrate/granulomas). the findings are consistent with chronic allograft nephropathy. no overt diabetic changes are seen eeg - abnormal eeg due to an overall generally low voltage record with marked slowing, somewhat accentuated over the right hemisphere at times. this would indicate a diffuse mild to moderate encephalopathy with the possibility of intermittent vascular insufficiency involving rightsided structures. no discharging features were seen nephrostomy catheter drainage - no evidence of transplant kidney hydronephrosis or ureteric stenosis. free flow of contrast was seen from the renal transplant collecting system to the bladder. a collection of contrast is seen just inferior to the renal transplant kidney. although this may be related to the right ureteric remnant, a contrast leak cannot be entirely excluded. note that a leakage site was not definitely identified r upper ext us - no dvt 1:22 pm urine **final report ** urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. trimethoprim/sulfa sensitivity testing confirmed by . 2nd isolate. <10,000 organisms/ml. 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 cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. respiratory culture (final ): oropharyngeal flora absent. klebsiella pneumoniae. heavy growth. 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 e. coli and klebsiella species. trimethoprim/sulfa sensitivity testing available on request. acinetobacter baumannii. sparse growth. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | acinetobacter baumannii | | ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- r =>64 r ceftazidime----------- =>64 r =>64 r ceftriaxone----------- r cefuroxime------------ =>64 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s =>16 r imipenem-------------- <=1 s =>16 r levofloxacin---------- =>8 r =>8 r meropenem-------------<=0.25 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r 8 i 3:36 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no staphylococcus aureus isolated. 3:36 pm swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): enterococcus sp.. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r chloramphenicol------- <=4 s levofloxacin---------- =>8 r linezolid------------- 2 s penicillin------------ =>64 r vancomycin------------ =>32 r 9:30 pm urine on nephrostomy output. **final report ** urine culture (final ): yeast. >100,000 organisms/ml.. gram stain (final ): this is a corrected report . >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). . previously reported as . 4+ (>10 per 1000x field): gram negative diplococci. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. oropharyngeal flora absent. gram negative rod(s). moderate growth. of three colonial morphologies. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs. smear reviewed; results confirmed. respiratory culture (final ): oropharyngeal flora absent. acinetobacter baumannii. >100,000 organisms/ml.. trimethoprim/sulfa sensitivity testing available on request. sensitive to amikacin. sensitivities: mic expressed in mcg/ml _________________________________________________________ acinetobacter baumannii | cefepime-------------- =>64 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 8 i levofloxacin---------- =>8 r tobramycin------------ 8 i clostridium difficile toxin assay (final ): reported by phone to brandy cross on at 11:40a fa10. clostridium difficile. feces positive for c. difficile toxin by eia. reference range: negative. a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). 4:16 pm urine **final report ** urine culture (final ): acinetobacter baumannii. >100,000 organisms/ml.. unasyn (ampicillin/sulbactam) sensitivity confirmed by . amikacin sensitive by . yeast. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ acinetobacter baumannii | ampicillin/sulbactam-- <=2 s cefepime-------------- =>64 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 8 i levofloxacin---------- =>8 r tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r brief hospital course: patient admitted following ureteropyelostomy of patient's left ureter to transplanted kidney for stricture. patient tolerated the procedure well, and was directly admitted intubated and sedated to the surgical intensive care unit for stabilization and postoperative care. patient was resuscitated with prbc for postoperative anemia and low volume status as evaluated by poor urinary output and cvp around . patient was given fluid boluses and prbc to maintain vascular volume, but poor urine output continued, and atn was considered, with renal consulted. renal felt that the oliguria of patient was likely secondary to obstruction, as the operation did not have episodes of hypotension, large blood loss, or asystole to justify atn. patient did not have need for hd as patient was not fluid overloaded and electrolytes were appropriate. a pulmonary artery catheter was placed for accurate pressure and volume recordings. on pod#2 the patient was started on tpn and had sedation weaned to work towards extubation. renal felt that the problem was multifactorial atn (based on urine sediment analysis) +/- stent positioning in the newly constructed ureter. patient was taken to ir on pod#2 for nephroureteral stent repositing, echo was also obtained for heart function with results listed above. renal us on showed new blunting of arterial waveform and increased ri. patient continued on his anti-rejection medications during this time, while on pod#4 patient began to mobilize fluid and lasix was started to improve anuric condition of patient. patient was attempted to be weaned off of the vent, but despite good respiratory mechanisms and oxygenation, patient was not ready to protect airway and remained intubated. patient was started on fluconazole at this time for presence of yeast in the patient's urine, and hd to remove extra fluid in addition to the lasix administration, and for rising creatinine that may have contributed to the patient's difficult extubation on , and altered mental status on for which neurology was consulted in addition to facial droop as reported by patient's daughter. ct of the noted no acute bleed or process and patient was started on asa 325mg. patient had eeg administered to r/o nonconvulsive status epilepticus and consideration of toxic metabolic etiology, with above noted results. wound care was obtained on for sacral decubitus ulcer care, and left heel wound care. patient was intubated for altered mental status and maintained sedated. on patient spiked a fever to 101.3 and vanco/zosyn started empirically. tube feeds were started, and tpn stopped on , while id recommendations had patient switch abx coverage to linezolid and meropenem, with continuance of bactrim and fluconazole. patient had episodes of desaturation with secretions, improving with suction and albuterol nebs. urine cultues showed infection with ecoli covered by current antibiotic regimen. for slowly falling hct, patient was given one unit on , along with discontinuing his cvl. vent weans were restarted on pod13, and patient was bronch'd showing gpc in pairs and gnr. speech and swallow at the bedside showed low aspiration risk for food to patient, though basic aspiration precautions were performed. patient was extubated on and on infectious disease was consulted for resistant sputum microorganisms and vent-associated pna, e.coli/fungi urine culture. infectious disease recommended replacing the foley to clear the fungemia, a ct abdomen to r/o urinoma and other pelvic sources had above-noted results. patient transferred from icu to regular surgical floor on . on the hepatology service was consulted to r/o hemochromatosis as patient felt to be "bronze" in appearance with elevated ferritins, cirrhotic liver appearance in or, and patient having diabetes. etiology of patient's cirrhosis unclear, but thought secondary to nash, viral hepatitis, or atypical hemochromatosis. once on floor, tf were held, and po intake encouraged. physical therapy began working with the patient on , and hd sessions continued per renal's recommendations. on while moving patient to stretcher, patient was noted to have discordant movement of eyes, though medical doctor examination showed no focal neurological deficits. neurology was reconsulted with above noted eeg findings from patient did not have recommended mri performed because of patient did not tolerate the procedure. patient had poor po intake throughout surgical floor hospitalization period, as monitored by serial calorie counts, and episodes of hypoglycemia for which was consulted and monitored/administered needed insulin therapy for the patient. patient displayed continued rising creatine and repeat ct of abdomen showed hydro of tx kidney and of right native kidney with ? of early abscess at inferior pole of kidney, along with question of colitis. id was reconsulted for these new findings, and flagyl was started for c.diff colitis, while fluc and meropenem was continued for funguria, and drainage of inferior kidney pole fluid collection recommended. to assess for the salvagability of the tx kidney, a biopsy was performed on with above noted results. patient had dobhoff tube placed for feeding purposes, but patient removed dobhoff manually during evening of . on patient was found on ground of hospital room floor after falling out of bed, while later in evening patient complained of chest pain and right shoulder pain. this latest ct of head was negative and ekg obtained during chest pain episode was similar and consistent with prior readings. dobhoff tube was replaced on but patient removed it from his nose by the morning of . routine hd, wound care, abx administration, and encouragement of po intake continued with no serious events, and on , nephrostomy tube study showed small leak, whereby we maintained the nephrostomy tube to drainage and jp drain to drainage. food was supplemented with boost for nutritional support, but po intake remained poor. on , patient began screening process for rehab placement, and repeat jp drainage analysis did not show evidence of urinary leakage, with creatinine near serum levels. abx coverage, pt, and ot were continued for patient rehabilitation. picc venous access catheter was placed on for iv abx administration and for access, but patient found rehab bed on and had picc line removed. repeat jp creatine emulated serum creatinine, and therefore jp drain was removed on prior to transfer to extended care facility. medications on admission: 1. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain/fever. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 5. epoetin alfa 3,000 unit/ml solution sig: two (2) injection qmowefr (monday -wednesday-friday). 6. sodium bicarbonate 650 mg tablet sig: two (2) tablet po bid (2 times a day). 7. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po hs (at bedtime) as needed. 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 9. tacrolimus 1 mg capsule sig: two (2) capsule po bid (2 times a day) for 2 doses. 10. glargine sig: six (6) units at bedtime. 11. insulin lispro (human) 100 unit/ml solution sig: follow sliding scale subcutaneous four times a day: see printed sliding scale. 12. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). 13. meropenem 1 g recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 14. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): check level twice a week. 15. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: via picc after flushing with 10ml of saline. discharge medications: 1. tacrolimus 1 mg capsule sig: one (1) capsule po bid (disp:*30 capsule(s)* refills:*2* 2. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. acetaminophen 325 mg tablet sig: one (1) tablet po every hours as needed for fever or pain. 7. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po qhs (once a day (at bedtime)). 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 9. papain-urea unit-mg/g ointment sig: one (1) appl topical daily (daily). 10. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours). 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical daily (daily) as needed. 12. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). tablet(s) discharge disposition: extended care facility: rehab discharge diagnosis: ureteral stricture discharge condition: stable discharge instructions: please return to hospital er for fever greater than 101.4, worsening abdominal pain, increasing nausea/vomiting, or signs of a wound infection: increasing incisional redness, swelling, tenderness, or drainage of purulent fluid. nylon suture in right lower quadrant of abdomen may be removed after followup instructions: please follow up with dr. of transplant surgery in 2 weeks; please call to schedule an appointment procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis closed [endoscopic] biopsy of bronchus closed [percutaneous] [needle] biopsy of kidney pulmonary artery wedge monitoring transfusion of packed cells diagnostic ultrasound of urinary system injection or infusion of oxazolidinone class of antibiotics percutaneous pyelogram percutaneous pyelogram replacement of nephrostomy tube anastomosis of kidney replacement of ureterostomy tube diagnoses: acute kidney failure with lesion of tubular necrosis candidiasis of other urogenital sites chronic kidney disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease intestinal infection due to clostridium difficile pressure ulcer, lower back hydronephrosis complications of transplanted kidney diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status pneumonia due to klebsiella pneumoniae ulcer of heel and midfoot stricture or kinking of ureter facial weakness 

Answer: The patient is high likely exposed to