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: altered mental status major surgical or invasive procedure: picc line bronchoscopy and history of present illness: ms. is an 85 year-old woman with resp failure/vent dependent s/p trach, recent pes, schf (ef 25%), af, and pvd who is transferred from rehab because of unresponsiveness and low tidal volumes and is admitted to micu for further management. . she was discharged on from the thoracics service after presenting from an osh with tracheal laceration in the setting of traumatic intubation and sub-cutaneous emphysema post-intubation. her recent history prior to that includes a fall on with a c2 odontoid fracture and diagnosis of pes in the setting of dyspnea on requiring intubation (complicated by trach injury) for hypercapnea. on the thoracics service, she multiple bronchoscopies and trach placement ((#7 ) and revisions with clot demonstrated in posterior trachea and trach dislodgement. she was discharged on trach cpap with cmv onvernight. she was transitioned from cmv ventilation to cpap, and was able to tolerate trach collar for unspecified periods of time. . at rehab, she had ams/unresponsiveness which is different from her baseline, and low tidal volumes on pressure support and was transferred to the for further management. abg 7.24/44/91 (?may be an error) and 98.6 74 26 95/61 92% on fio2 40% per rehab notes. . in the ed, vital signs were initially: 99 61 106/49 100% on vent. cxr showed pleural effusions but no acute findings and ip was consulted and felt trach was in good position and she did not need urgent intervention. thoracics was also notified and will follow the patient. head ct neg. ua was grossly positive and cipro was started. she was also on a heparin gtt on arrival and this was stopped when coags returned within inr 6. she was then admitted for further management. past medical history: 1. possible cad 2. congestive heart failure, possible ef of 25% (per report) 3. copd 4. atrial fibrillation 5. lbbb 6. pvd 7. arthritis 8. mrsa infection in the pasy 9. squamous cell carcinoma of right arm 10. dementia 11. odontoid fracture in collar 12. hyperlipidemia social history: + tobacco, recently quit. no illicits or etoh per report. widowed, lives with son . healthcare proxy is son . family history: no cad or arrhythmia physical exam: tmax: 37.7 ??????c (99.8 ??????f) tcurrent: 37.6 ??????c (99.6 ??????f) hr: 65 (48 - 82) bpm bp: 99/41(56) {90/21(39) - 135/71(82)} mmhg rr: 18 (13 - 22) insp/min spo2: 100% heart rhythm: af (atrial fibrillation) height: 61 inch general appearance: no acute distress, thin eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, trach cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: not assessed), (left radial pulse) not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) extremities: right lower extremity edema: 3+, left lower extremity edema: 3+ (bilaterally to the thighs) skin: not assessed, no(t) rash: neurologic: minimally responds to: verbal stimuli, movement: spontaneous, tone: not assessed, perrl, withdraws to painful stimuli, upgoing toesneurologic: responds to: not assessed, movement: not assessed, tone: not assessed pertinent results: admission: 02:18am blood wbc-8.0 rbc-2.95* hgb-9.4* hct-30.2* mcv-102* mch-31.8 mchc-31.0 rdw-16.7* plt ct-218 12:15pm blood neuts-92.7* lymphs-3.7* monos-3.3 eos-0.2 baso-0.1 02:18am blood pt-16.3* ptt-55.8* inr(pt)-1.4* 02:18am blood glucose-153* urean-24* creat-0.3* na-143 k-3.7 cl-115* hco3-24 angap-8 12:15pm blood alt-21 ast-24 ld(ldh)-188 ck(cpk)-16* alkphos-44 totbili-0.2 10:30am blood lipase-29 02:18am blood calcium-9.3 phos-3.4 mg-2.2 12:15pm blood vitb12-471 folate-greater th 12:15pm blood tsh-1.0 12:15pm blood free t4-1.1 10:30am blood ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:39pm blood type- po2-87 pco2-52* ph-7.26* caltco2-24 base xs--4 comment-green top 11:17am blood glucose-158* lactate-2.0 na-145 k-4.5 cl-112 calhco3-24 discharge: 04:22am blood wbc-4.5 rbc-2.65* hgb-8.7* hct-25.7* mcv-97 mch-33.0* mchc-34.0 rdw-16.8* plt ct-129* 04:22am blood pt-17.2* ptt-30.3 inr(pt)-1.5* 04:22am blood glucose-114* urean-26* creat-0.5 na-139 k-3.7 cl-107 hco3-25 angap-11 02:50pm blood ld(ldh)-194 totbili-0.5 12:15pm blood lipase-27 03:17am blood ck-mb-notdone ctropnt-0.03* 12:15pm blood ctropnt-0.03* 04:22am blood calcium-8.5 phos-2.7 mg-2.1 02:50pm blood hapto-168 11:00 am sputum source: endotracheal. gram stain (final ): pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. 3+ (5-10 per 1000x field): gram negative rod(s). respiratory culture (preliminary): further incubation required to determine the presence or absence of commensal respiratory flora. gram negative rod(s). moderate growth. 8:30 pm urine source: catheter. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. 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 _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- =>64 r ceftazidime----------- r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ 4 s meropenem-------------<=0.25 s nitrofurantoin-------- 64 i piperacillin/tazo----- 32 i tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r urine culture (final ): escherichia coli. >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. klebsiella pneumoniae. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | klebsiella pneumoniae | | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r <=2 s cefazolin------------- =>64 r <=4 s cefepime-------------- 32 r <=1 s ceftazidime----------- r <=1 s ceftriaxone----------- =>64 r <=1 s ciprofloxacin--------- =>4 r <=0.25 s gentamicin------------ 2 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i <=16 s piperacillin/tazo----- 32 i <=4 s tobramycin------------ 4 s <=1 s trimethoprim/sulfa---- =>16 r <=1 s blood cultures: ngtd ct head impression: 1. no definite acute intracranial pathology. no bleed or evidence for acute vascular territorial infarction. however, if there is concern for acute infarct, mri with diffusion- weighted imaging, if feasible, is more sensitive. 2. chronic small vessel microvascular infarction and global parenchymal atrophy. 3. secretions within bilateral sphenoid and right mastoid apical air cells, some of which may relate to the (reported) presence of tracheostomy. cxr : the et tube tip is 4 cm above the carina. cardiomediastinal silhouette is unchanged. there is slight interval improvement in vascular engorgement. no change in bibasal left more than right atelectasis is seen. brief hospital course: # acute on chronic respiratory failure: the patient was admitted due to altered mental status and low tidal volumes. the patient with known traumatic intubation at osh c/b tracheal injury, and trached here requiring multiple revisions. also with copd. patient went into respiratory distress with hypoxia and hypotension. she was started on levophed and emergent bronch. the bronch showed granulation tissue obstructing 95% of her tube. the tube was passed farther down past the site of obstruction and the patient's respiratory status improved and was weaned off levophed. the patient then repeat bronch the following day on that showed the tube to be patent and the tracheal laceration to be healing well. the patient's respiratory status remained stable and her ventilator settings at the time of dicharge were: cmv, vt (set):450, rr (set): 14, peep: 5 cmh2o, and fio2: 40%. the patient was also treated for a vap based on cxr (left retrocardiac opcaity and increasing sputum). she was started on vanco/cefepime on for presumed vap. she was then changed to vanco/meropenem given her esbl urine cx results. her sputum subsequently grew out gnr and she will continue vancomycin and meropenem for a planned 8 day course (last day:). a picc line was placed on . the patient did have a low grade temp of 100.5 at the time of discharge. this was discussed with dr. at and is aware. #. vap: see above for respiratory course. patient with planned 8 day course of meropenem with final day being . sputum is currently growing gnr and needs to be followed up for final speciation and sensitivities. #uti: the patient was intially treated with ciprofloxacin on admission for a positive ua. she was then broadened to vanco/cefepime given she was at rehab for resistant organisms. the ucx returned esbl e. coli and was switched to meropenem for a planned 8 day course (last day ). # altered mental status: the patient came in minimally reactive which was a change from her baseline per the family. her change in mental status was attributed to her infection and after treatment for her vap and uti her mental status returned to baseline. she is able to follow very simple commands and answer some simple yes/no questions. # chf: the patient had an ef 25% per report. her metoprolol and lisinopril was held given her infection and normal blood pressure. additionally, her lasix was initially held. the patient was restarted on her metoprolol at 12.5mg , but several doses were held secondary to hypotension and bradycardia. her blood pressure and heart rate should be monitored at rehab and titrate metoprolol accordingly. the patient was restarted on her lasix 20mg po bid given her volume overload. her weight, respirtory status and i/o should be monitored and lasix titrated at rehab. #anemia: the patient admission hct was 26 and slowly trended down to hct 21. her hemolysis labs were negative and there were no signs of active bleeding. her guaiac was negative. she was trnasfused one unit and her hct remained stable. upon discharge her hct was 25.7. # pes: patient with recent diagnosis in . the patient was continued on coumadin 3mg daily and brdiged with lovenox 60mg q12 for a subtherapeutic inr. upon discharge her coumadin was increased to 5mg daily and continued on lovenox 60mg until inr >2.0. # c2 fracture: patient with c2 fracture after a fall on . she was maintained on a j-collar. the patient should have follow-up with neurosurgery as an outpatient. # afib: patient's metoprolol was initially held due to ongoing infection. her metoprolol was restarted on 12.5mg and continued on systemic coagulation. medications on admission: 1. chlorhexidine gluconate 0.12 % mouthwash : five (5) ml mucous membrane (2 times a day). 2. therapeutic multivitamin liquid : five (5) ml po daily 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours). 4. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 5. metoprolol tartrate 25 mg tablet : one (1) tablet po bid 6. furosemide 20 mg tablet : one (1) tablet po bid 7. potassium chloride 20 meq packet : one (1) packet po twice a day: adjust as labs or lasix adjusted. 8. oxycodone-acetaminophen 5-325 mg/5 ml solution : five (5) ml po q6h (every 6 hours) as needed for pain. 9. acetylcysteine 20 % (200 mg/ml) solution : three (3) ml 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : three (3) ml inhalation (2 times a day). 11. warfarin 3 mg tablet : one (1) tablet po at bedtime: goal inr for afib . rehab md to adjust coumadin dose based on inr. stop heparin gtt once inr >2.0. 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one po daily 13. sodium chloride 0.9% flush 10 ml iv prn line flush 14. lisinopril 2.5 mg tablet : one (1) tablet po daily 15. simvastatin 20 mg tablet : one (1) tablet po at bedtime. 16. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution : seven hundred (700) units intravenous asdir (as directed): adjust for ptt 60-80. check q 6 hrs or per protocol if stable >24 hrs. stop when inr >2.0. discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 3. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation qid (4 times a day). 4. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 5. oxycodone-acetaminophen 5-325 mg/5 ml solution : five (5) ml po q6h (every 6 hours) as needed for pain. 6. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day) as needed for mouthcare. 7. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 8. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po bid (2 times a day). 9. therapeutic multivitamin liquid : five (5) ml po daily (). 10. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 11. acetylcysteine 20 % (200 mg/ml) solution : one (1) ml miscellaneous q6h (every 6 hours) as needed for thick secretions. 12. enoxaparin 60 mg/0.6 ml syringe : one (1) subcutaneous q12h (every 12 hours). 13. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours) as needed for wheezes. 14. furosemide 20 mg tablet : one (1) tablet po bid (2 times a day). 15. warfarin 2 mg tablet : two (2) tablet po once daily at 4 pm. 16. famotidine 20 mg tablet : one (1) tablet po q12h (every 12 hours). 17. meropenem 500 mg recon soln : one (1) recon soln intravenous q6h (every 6 hours). 18. vancomycin 1,000 mg recon soln : one (1) intravenous q 24h (every 24 hours). discharge disposition: extended care facility: - discharge diagnosis: urinary tract infection- e.coli (esbl) pneumonia discharge condition: level of consciousness:lethargic but arousable activity status:bedbound mental status:patient has trach, arousable but not following any commands discharge instructions: you were admitted to the hospital for concerns of a urinary traction infection and pneumonia. you were treated with antibiotics and will need to complete this course while at rehab. followup instructions: procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma diagnoses: abnormal coagulation profile anemia, unspecified unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation peripheral vascular disease, unspecified other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia acute and chronic respiratory failure other left bundle branch block chronic systolic heart failure long-term (current) use of anticoagulants personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use ventilator associated pneumonia gastrostomy status tracheostomy status 

Answer: The patient is high likely exposed to