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: haldol / ativan attending: chief complaint: hematemesis major surgical or invasive procedure: paracentesis (diagnostic and therapeutic) arterial line placement central venous line placement picc line placement intubation mechanical ventilation bronchoscopy endoscopy picc line placement history of present illness: 58 y/o m with history of alcoholic cirrhosis (grade i varices on nadolol, recent gi bleed at , mutliple paracentesis, never had sbp) who presented with hepatic encephalopathy, developed hematemesis while on -, and transferred to icu for further management. he initially presented with dyspnea for the past few days to weeks and altered mental status. no ligthheadedness, cough, fever. complains of abdominal pain to palpation. of note, the patient reports still drinking. he says his last drink was . in the er, intial vitals 97.3, bp 110/50, 70, 18, 96% ra. he was given 2l ns, kayexalate 30g po, lactulose 30mg po, levofloxacin 750mg ivx1 and flagyl 500mg iv x1 to treat hepatic encephalopathy and prophylaxis for sbp. he was empirically treated with ceftriaxone. patient underwent a paracentesis on that revealed 134 wbc in ascitic fluid. in the evening of he vomited up about 50 cc of bright red blood. sbp was in the 130s then 110s, hr 70s. he briefly desated to 90% on nc and was put on face mask. transferred to micu for further management. past medical history: 1) copd - not o2- or steroid-dependent 2) etoh abuse - no h/o dt's, withdrawal symptoms, last drink 6 months ago per pt. 3) pvd s/p aortobifemoral bypass ~10 yrs ago 4) htn 5) gerd 6) pancreatic mass 7) remote pud 8) anxiety d/o 9) cirrhosis with phtn s/p tap x1 10) dm2 social history: retired. continues to drink 2 glasses/wine most days of the week. smokes ppd. has a 80 pack year smoking history. no illicit substances. used to work at a car dealership. family history: mother - pvd; father - cva; two daughters healthy; no known h/o liver disease or malignancy physical exam: admission physical exam: vitals: t: 98.2 bp: 114/78 p: 63 rr: 15 o2sat: 100% on 2l. gen: confused, jaundiced obese male heent: dry mm, scleral icterus neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or gallops lungs: crackles at bases abd: distended, typanetic, shifting dullness, tense ext: 4+ edema skin: no lesions neuro: confused, +flapping asterixis . micu physical exam (): vitals: t: 95.9 bp: 126/60 p: 116 rr: 11 o2sat: 97% on vent. gen: intubated, sedated heent: ett in place neck: supple, no lad, no jvd cv: tachy, regular, nl s1, s2. no murmurs, rubs or gallops lungs: course bs at bases, no bases abd: distended, slighty tense, hyperactive bs ext: 2+ edema neuro: sedated . micu physical exam (): t 99.2, hr 96, bp 114/63, rr 20, o2 sat 98% on ra gen: no acute distress, obese, oriented to self, not place or time heent: l eye dilated, +dobhoff cv: rrr, nl s1, s2. no murmurs, rubs or gallops lungs: symmetric, coarse breath sounds anteriorly bilaterally abd: soft, non-tender, bs+, distended, + fluid wave, + bulging flanks extremities: warm and well perfused, 2+ edema in both upper and lower extremities, 1+ pulses in distal extremities neurologic: aao x 0-1, + asterixis pertinent results: admission labs: ================ 02:05pm wbc-9.0 rbc-3.43* hgb-12.4* hct-37.9* mcv-111* mch-36.2* mchc-32.7 rdw-18.8* 02:05pm neuts-67.4 lymphs-21.5 monos-8.6 eos-1.5 basos-1.0 02:05pm plt count-128* 02:05pm pt-20.3* ptt-44.4* inr(pt)-1.9* 02:05pm ammonia-159* 02:05pm ck-mb-5 ctropnt-0.04* 02:05pm alt(sgpt)-300* ast(sgot)-889* ck(cpk)-162 alk phos-295* tot bili-14.8* 02:05pm glucose-80 urea n-45* creat-3.2*# sodium-129* potassium-8.9* chloride-97 total co2-20* anion gap-21* 02:16pm lactate-2.2* discharge labs: : wbc 14.6, hct 24.6, plts 104 calcium 8.8, mg 1.7, phos 3.8 sodium 138, k 3.5, cl 96, hco3 23 bun 10, cr 0.8 inr 1.9 studies: ========= abdominal u/s impression: 1. limited evaluation of hepatic parenchyma with moderate ascites noted. please note that diffuse and more advanced liver disease (i.e., hepatic fibrosis/cirrhosis) cannot be excluded on this study. 2. limited doppler evaluation of the liver with to-and-fro portal vein flow again suggestive of portal hypertension. abdominal xray impression: multiple dilated loops of small bowel, concerning for obstruction. abdominal u/s impression: moderate four-quadrant ascites. right lower quadrant largest pocket marked for paracentesis to be performed by the clinical team. abdominal xray impression: worsened appearance of small bowel obstruction. ct abd/pelvis impression: 1. mildly dilated loops of small bowel which decompress in the distal ileum, without evidence of a discrete transition point. 2. new right greater than left small pleural effusions and adjacent atelectasis. renal u/s impression: no evidence of hydronephrosis bilaterally, as questioned. a small echogenic focus at the right interpolar region shows no shadowing, and may represent a small crystal or early atherosclerotic change within a renal artery branch. large-volume ascites. ct chest/abd/pelvis impression: 1. increased patchy opacities in the bilateral lungs with bibasilar consolidations concerning for multifocal pneumonia. 2. no evidence of obstruction. 3. persistent ascites, unchanged. 4. mediastinal lymphadenopathy as described above which may be reactive. tte the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 70-80%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricle now appears hyperdynamic. impression: no obvious vegetations seen, but technically suboptimal study portable cxr feeding tube and central venous catheter remain in place. cardiomediastinal contours are unchanged. widespread bilateral alveolar and interstitial opacities have slightly worsened in the interval and may reflect asymmetric pulmonary edema, with or without superimposed process such as infection or aspiration. upper endoscopy : multiple grade ii varices were seen in the esophagus at the ge junction. there were stigmata of recent bleeding with some oozing of one varix. 4 bands were successfully placed. upper endoscopy : 3 cords of grade ii varices were seen in the gastroesophageal junction. 3 bands were successfully placed. microbiology: ============== 4:04 pm sputum site: endotracheal source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): budding yeast with pseudohyphae. respiratory culture (final ): oropharyngeal flora absent. enterobacter cloacae. moderate growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- =>128 r tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s yeast. moderate growth. 6:30 pm blood culture source: line-picc. blood culture, routine (preliminary): enterobacter cloacae. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- 64 i tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). brief hospital course: 58 y.o. m with alcoholic cirrhosis s/p esophageal banding for variceal bleed, who presented with hepatic encephalopathy on requiring multiple icu transfers for respiratory failure and intubation, likely secondary to aspiration events. respiratory failure / aspiration pneumonia: the patient had recurrent aspiration events (x2) which caused multifocal pna and sepsis requiring broad spectrum abx (meropenem for esbl enterobacter and empiric vancomycin). his pna improved and superimposed pulmonary edema (as a result of fluid resuscitation) was diuresed off. his sepsis resolved w/ treatement of his pneumonia on both occasions and the patient required short courses of stress dose steroids in order to be weaned off of pressors. during his hospitalization the patient had a code blue called for respiratory code for both of his aspiration events, both requiring intubation. disucssions were held with the family and the patient regarding tracheostomy which would not help prevent aspiration but would improve our management of likely future aspiration events; the patient and family decided to pursue tracheostomy. however, pt self-extubated on prior to procedure and subsequently was able to manage his secretions adequately. at the time of discharge he was maintaining oxygen saturations in the mid 90s on room air. gi bleed: secondary to variceal hemorrhage. the patient had egd x 2 for variceal banding and following initial bleed the patient was very stable. he was transitioned from ppi gtt to iv dosing. he was transfused 1 u prbc on for anemia to 22 which had gradually trended down from 26 several days earlier. cirrhosis: related to etoh abuse. the patient was an active etoh abuse prior to admission to the hospital so had not been a candidate for liver transplant. the patient underwent diuresis w/ lasix and 1 therapeutic paracentesis of 4l. he was continued on rifaximine and lactulose although the dose of the latter was decreased to maintain more regular dosing given concern for increasing tremor with skipped doses. his diuretics are currently being held and will need to be restarted as an outpatient. he continues to have a significant degree of hepatic encephalopathy complicated by icu delerium which makes it difficult to maintain the security of lines and tube without restraints. he currently opens his eyes to voice and will follow simple commands but is oriented only x 1 with significant asterixis. he frequently requires restraints. he will follow up with the hepatology center for further management. ileus: the patient was started on standing reglan, this was weaned off on . thrombocytopenia: the patient was noted to have fluctuating platelet counts during his hospitalization. the nadir of his platelets was 44. the etiology was felt to be related to bone marrow suppression, his underlying liver disease, as well as related to his antibiotics (meropenem). it was felt to be less likely related to heparin given the time course. when the patient was restarted on meropenem for enterobacter bacteremia. his platelet count slowly trended down when meropenem was restarted. he will need close monitoring of his platelet count while at rehab. bacteremia: patient grew enterobacter sensitive to meropenem on bcx from picc. brief vanco course given for gpc in bcx from left ij which returned with coag negative staph, likely contaminant. picc and ij were both removed, and new picc placed on . to complete 14-day course of meropenem (last dose on ). as above, starting meropenem was again associated with a trending down of his platelet count. his platelets will need to be monitored closely while on this medication. hypernatremia: patient was noted to have elevated serum sodium secondary to decreased po intake. this resolved with free water flushes per ngt. . diabetes mellitus: controlled on nph and humalog insulin sliding scale. fen: the patient had pulled out feeding tubes (ngt x 1, dobhoff x 2) but dobhoff replaced without further incident once patient was placed in mitts and restraints. he will need to continue on tube feeds for nutrition with free water flushes for hypernatremia. prophylaxis: pneumoboots and sc heparin code status: full communication: girlfriend , phone: medications on admission: albuterol as needed advair 250mcg/50mcg twice daily folic acid 1mg daily lasix 80mg daily glimepiride 4mg daily lantus 36units every morning humalog sliding scale nadolol 30mg daily omeprazole 40mg daily spironolactone 100mg daily aspirin 81mg daily benadryl 25mg daily multivitamin thiamine medications upon transfer to icu insulin sc sliding scale & fixed dose lactulose 30-60 ml po qid titrate to bm/day albuterol 0.083% neb soln 1 neb ih q2h:prn sob ampicillin/sulbactam 3gm iv q6h day 1= vancomycin 100mg iv q12 multivitamins 1 tab po daily octreotide acetate 50 mcg/hr iv drip infusion cyanocobalamin 100 mcg po daily ondansetron 4 mg iv q8h:prn nausea fluticasone-salmeterol diskus (250/50) 1 inh ih pentoxifylline 400 mg po tid folic acid 1 mg po daily rifaximin 400 mg po tid thiamine 100 mg po daily furosemide 40mg daily pantoprazole 40mg iv bid spironolactone 100mg daily discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for wheezes. 2. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for wheezes. 3. folic acid 1 mg tablet : one (1) tablet po daily (daily). 4. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 5. cyanocobalamin 100 mcg tablet : one (1) tablet po daily (daily). 6. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed for rash. 7. therapeutic multivitamin liquid : five (5) ml po daily (daily). 8. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 9. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po tid (3 times a day) as needed for agitation. 10. lactulose 10 gram/15 ml syrup : thirty (30) ml po q6h (every 6 hours). 11. meropenem 1 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours) for 6 days: to end on . 12. ondansetron 4 mg iv q8h:prn nausea 13. artificial tears ointment : one (1) application ophthalmic once a day as needed for dry eyes: to both eyes. 14. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. 15. insulin nph human recomb 100 unit/ml cartridge : thirty (30) units subcutaneous twice a day. 16. humalog 100 unit/ml cartridge : one (1) units subcutaneous four times a day: 0-70 - 1 amp d50 71-150 - 0 units 151-200 4 units 201-250 8 units 251-300 12 units 301-350 16 units 350-400 20 units. 17. dextrose 50% 25 gm iv prn glucose <70 18. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr twice a day. discharge disposition: extended care facility: tcu - discharge diagnosis: hepatic encephalopathy esophageal varices aspiration pneumonia enterobacter bacteremia discharge condition: hemodynamically stable discharge instructions: you were admitted for treatment of hepatic encephalopathy. you had a episode of bloody vomiting and found to have esophageal varices which were banded. your hospital course was complicated by two episodes of respiratory failure thought to be due to aspiration of secretions. you were treated for pneumonia. you are now successfully extubated and managing your secretions adequately. you do have an infection in your blood for which you will need to continue antibiotics. you will be transferred to a rehab center for further care. please take all your medications as prescribed. please keep all your follow up appointments as scheduled. please seek immediate medical attention if you experience any fevers > 101.5 degrees, chest pain, difficulty breathing, worsening abdominal distension, abdominal pain, bloody emesis, black or bloody bowel movements, or any other concerning symptoms. followup instructions: please follow up with your pcp after discharge from rehab. provider: , md phone: date/time: 3:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization closed [endoscopic] biopsy of bronchus endoscopic excision or destruction of lesion or tissue of esophagus endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: esophageal reflux pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis toxic encephalopathy unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver severe sepsis portal hypertension chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases candidiasis of mouth anxiety state, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin paralytic ileus pressure ulcer, buttock pressure ulcer, lower back other septicemia due to gram-negative organisms unspecified accident other ascites esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy injury to bladder and urethra, without mention of open wound into cavity hyperosmolality and/or hypernatremia other and unspecified coagulation defects surgical or other procedure not carried out because of contraindication other and unspecified alcohol dependence, unspecified hematuria, unspecified delirium due to conditions classified elsewhere other specified diseases of pancreas acute alcoholic hepatitis pressure ulcer, stage ii personal history of peptic ulcer disease 

Answer: The patient is high likely exposed to