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: vancomycin attending: chief complaint: lethargy, hypotension, hypothermia major surgical or invasive procedure: none history of present illness: 68m with multiple sclerosis, neurogenic bladder w/ foley w/ utis, and seizures transferred from for lethargy, hypotension, hypothermia, and initial evaluation suggestive of urosepsis. pt increasingly lethargic, bps 90/50s responsive to 2l crystalloid. osh w/u showed wbc 7, baseline thrombocytopenia, na 131, k 6.3 (improved 5.5 after fluids), prerenal azotemia (35/1.1) without acidosis, normal lactate (1.5) and lfts. cxr reportedly normal. dilantin level 15, nontoxic. ecg showed sinus bradycardia, prolonged pr, with slowed ventricular conduction, no ischemia or signs of hyperkalemia. ua with large pyuria, nitrite positive, presumed infectiuos source. empirically treated with 1g vanc, 1g ceftriaxone (h/o mrsa, yeast, candidal utis) prior to transfer. . in ed, t 95, hr 57, bp 127/68, rr 16, 98% on 2l nc (bp was initially 80/40 but on recheck was found to be 120s/60s - placement of cuff was questionable). pt was nonverbal with tremors, diffuse weakness, warm extremities but slightly diminished pulses; no cvat, abd benign. got 1l ivf. put him on warming blankets. has been hd stable. bicarb 29 before ivf, improved to 21 afterwards. repeat k 5.4. repeat hct 32, likely dilutional. repeat u/a with pyuria, nitrite negative. intermittently answering questions, wife coming in. alert and responsive. last bp 135/60 - brighter affect. tx at family and neuro request. . on the floor, initial vitals were bp 127/62, hr 58, 95% ra, unable to obtain temp. pt is calm and cooperative, answering questions only with nodding or shaking head. denies pain. does not know why he is in the icu. explained infection and need to monitor bp and pt shook head in agreement. past medical history: - miltiple sclerosis - h/o uti - foley catheter, changed monthly - hld social history: he is a retired computer programmer. he had smoked very briefly from age 13 with a 10-pack-year smoking history. he has not had any environmental or occupational exposures. family history: his mother with breast cancer. father with stomach cancer. physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear lungs: decreased breath sounds on the right. no wheezes, rales, ronchi cv: faint heart sounds abdomen: soft, non-tender, non-distended, bowel sounds present, splenomegaly - spleen palpable several centimeters below costal margin gu: foley placement ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: flat affect, makes appropriate eye contact. cn 2-12 intact with exception of lower facial muscles - could not smile or puff cheeks on command, 3/5 strength on ue bilaterally, 0/5 strength in le bilat (pt agrees this is baseline for him) pertinent results: on admission: 09:49am blood calcium-9.3 phos-2.6*# mg-1.7 04:00pm blood glucose-97 urean-29* creat-0.8 na-136 k-5.4* cl-110* hco3-21* angap-10 04:00pm blood neuts-83.6* lymphs-12.0* monos-3.9 eos-0.5 baso-0.1 04:00pm blood wbc-5.0 rbc-3.63*# hgb-10.5*# hct-31.9*# mcv-88 mch-29.0 mchc-33.0 rdw-16.7* plt ct-73*# brief hospital course: mr. is a 68 y/o m with ms, neurogenic bladder w/ foley and utis who presents with urosepsis. . ## klebsiella urosepsis: mr. was transferred from after developing lethargy, hypotension, and hypothermia. he received 1g vanc and 1g ceftriaxone prior to transfer. n arrival here the patient was hd stable. received 1l ivf. given a warming blanket for hypothermia. mental status improved and was answering questions. admitted to the icu for hypothermia. in the icu, the patient remained hd stable. switched to meropenem based on urine culture growing esbl klebsiella. transferred to the medical on . on the floor the patient was hypothermic with waxing/ mental status. placed on warming blanket and vancomycin started. the following day the patient was febrile. transferred back to the icu where the patient continued to be hd stable. continued on vancomycin and meropenem and transferred back to the on . he continued to improve clinically from this point. his wbc fell, however, and given a prior question of whether vancomycin was causative, this was discontinued as there were no culture results revealing any mrsa infection, and clinical evidence of ongoing possible hospital associated pneumonia was limited (no sob, fevers, chest pain, cough). his cell counts recovered immediately after cessation of the vancomycin. home iv therapy has been arranged so that he can complete a total 14-day course of meropenem via picc line. . ## leukopenia, thrombocytopenia: this was attributed to vancomycin as stated above, which improved after vancomycin was stopped. . ## seizure disorder: during the hospitalization it was recognized that medications initiated in the icu and continued on the floor had several errors as his home medication regimen was identified to be different that the list maintained in omr. he was erroneously receiving keppra with dilantin, when he was suppposed to be on dilantin alone. this was explained to him and his wife, and apology offered and accepted. no evident harm resulted, and the keppra was discontinued and the medication list corrected and all providers involved notified of the error that was collectively made. . ## code status: full code as confirmed with patient during this admission. medications on admission: 1. baclofen 10 mg tablet sig: one (1) tablet po qid (4 times a day). 2. oxybutynin chloride 5 mg tablet sig: one half of one tablet po tid (3 times a day). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po hs (at bedtime). 5. methenamine hippurate 1 gram tablet sig: one (1) tablet po twice a day: to start on after completion of meropenem therapy on . 6. multivitamin tablet sig: one (1) tablet po once a day. 7. cranberry concentrate oral 8. vitamin c oral discharge medications: 1. baclofen 10 mg tablet sig: one (1) tablet po qid (4 times a day). 2. oxybutynin chloride 5 mg tablet sig: one half of one tablet po tid (3 times a day). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po hs (at bedtime). 5. meropenem 500 mg recon soln sig: five hundred (500) mg intravenous q6h (every 6 hours) for 8 days: last day of therapy . will need to have : cbc, chem 7, alt and ast checked on with results faxed to: , h. md address: bldg 1 ste #4 , , phone: fax: to ensure no neutropenia, renal failure, or liver toxicity while taking this medication . disp:*32 doses* refills:*0* 6. methenamine hippurate 1 gram tablet sig: one (1) tablet po twice a day: to start on after completion of meropenem therapy on . 7. multivitamin tablet sig: one (1) tablet po once a day. 8. cranberry concentrate oral 9. vitamin c oral 10. lab test sig: one (1) lab test once on for 1 days: cbc, chem 7, alt and ast checked on with results faxed to: , h. md address: bldg 1 ste #4 , , phone: fax: to ensure no neutropenia, renal failure, or liver toxicity while on meropenem therapy for uti. disp:*1 lab test* refills:*0* discharge disposition: home with service facility: area vna discharge diagnosis: esbl klebsiella uti with lethargy and hypothermia pancytopenia acute renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. activity status: out of bed with assistance to chair or wheelchair via -lift discharge instructions: you were admitted for lethargy and a low body temperature all concerning for septicemia related to a urinary tract infection and septicemia. you are being treated with antibiotics for both of the above conditions. you were initially on vancomycin and meropenem, however, you developed a low white blood cell count (leukopenia) which may have been caused by the vancomycin, so this was discontinued. you will continue meropenem when you go home. followup instructions: department: surgical specialties when: monday at 10:30 am with: , md building: campus: east best parking: garage department: adult specialties when: tuesday at 8:30 am with: , md building: (, ma) campus: off campus best parking: free parking on site md procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified hyperpotassemia urinary tract infection, site not specified unspecified septicemia hyposmolality and/or hyponatremia sepsis epilepsy, unspecified, without mention of intractable epilepsy hypoxemia metabolic encephalopathy multiple sclerosis neurogenic bladder nos hypothermia not associated with low environmental temperature other pancytopenia 

Answer: The patient is high likely exposed to