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: levaquin / lorazepam attending: chief complaint: chills, lower abdominal pain major surgical or invasive procedure: right ij central line history of present illness: the patient is an 83m with h/o mds and s/p cysto dilation of anterior urethral stricture 1 month ago, currently self-cathing for urine who presents with fever and dysuria. he saw his oncologist in clinic today and reported that over the past week, he has been having pain every time he self-caths and has been leaking urine. he has had low grade temps in the morning but on morning of admission, his temperature was 99.9 and he had shaking chills. . in the ed inital vitals were, 8 100 86 109/41 18 100% ra. his ua was consistent with uti and he was started on cefepime. his blood pressures were low, in the 80s, and he was given 3l ivf. given that he was also anemic, he was transfused 2 units prbcs. a rij was placed. . on arrival, he is comfortable and vitals are stable. . review of systems: see metavision past medical history: past oncological history: myelodysplastic syndrome s/p 4 cycles azacitidine (last dose in ); baseline immunosuppressed with white cell count ~ 2, and hematocrit in the mid 20's with frequent need for red cell transfusions other past medical history: cad s/p cabg dyslipidemia parkinson's disease depression/anxiety myelodysplastic syndrome hard of hearing social history: married, lives at home with wife. retired worker. - tobacco: remote - alcohol: none - illicits: none family history: non-contributory physical exam: vitals t:97.3 bp:120/48 hr:71 rr:15 02 sat:95% ra general: nad, well appearing skin: warm and well perfused, ecchymosis bilaterally on upper and lower extremities heent: nc/at, eomi, perrla, anicteric sclera, pink conjunctiva, mmm, nontender supple neck, no lad, no jvd. hard of hearing cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly gu: foley in place draining clear yellow urine, no scrotal edema ext: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact fex on discharge vitals - tm: 99.5 tc: 97.4 bp:130/58 hr:68 rr:20 02 sat:98%ra general: nad skin: warm and well perfused, no excoriations or lesions, no rashes heent: eomi, perrla, anicteric sclera, pink conjunctiva, mmm, nontender supple neck, no lad, no jvd cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly m/s: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact. no gross change to senosory or motor exam. pertinent results: blood 04:30pm blood wbc-6.2# rbc-2.18* hgb-8.6* hct-25.2* mcv-116*# mch-39.5*# mchc-34.1 rdw-20.4* plt ct-32* 03:14pm blood wbc-4.7 rbc-2.73* hgb-10.0* hct-29.4* mcv-108* mch-36.5* mchc-33.9 rdw-21.9* plt ct-22* 06:17am blood wbc-4.6 rbc-2.98* hgb-10.7* hct-32.8* mcv-110* mch-35.8* mchc-32.5 rdw-20.3* plt ct-31* 04:30pm blood neuts-76* bands-7* lymphs-12* monos-3 eos-0 baso-0 atyps-0 metas-2* myelos-0 04:30pm blood pt-14.6* ptt-38.2* inr(pt)-1.3* 03:14pm blood fibrino-594* 04:30pm blood glucose-117* urean-22* creat-1.1 na-139 k-3.7 cl-106 hco3-26 angap-11 06:50am blood glucose-96 urean-11 creat-0.8 na-142 k-3.8 cl-112* hco3-22 angap-12 06:17am blood glucose-97 urean-14 creat-0.8 na-142 k-3.5 cl-106 hco3-26 angap-14 03:07am blood alt-16 ast-31 ld(ldh)-161 alkphos-213* totbili-1.2 03:07am blood albumin-2.4* calcium-6.5* phos-2.6* mg-1.7 06:17am blood calcium-8.4 phos-3.8 mg-2.1 04:54pm blood lactate-1.6 08:53pm blood freeca-1.12 urine 04:30pm urine color-yellow appear-cloudy sp -1.013 04:30pm urine blood-lg nitrite-pos protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 04:30pm urine rbc-39* wbc->182* bacteri-many yeast-none epi-0 11:19am urine color-yellow appear-hazy sp -1.008 11:19am urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 11:19am urine rbc-143* wbc-143* bacteri-none yeast-none epi-0 microbiology urine cx : urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. klebsiella oxytoca. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | klebsiella oxytoca | | ampicillin/sulbactam-- 16 i 4 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i <=16 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s blood cx : ngtd, pending blood cx : ngtd, pending blood cx : ngtd, pending urine cx : ngdd, pending reports ekg : sinus rhythm. normal tracing. no previous tracing available for comparison. cxr : the tip of the right ij line lies at the cavoatrial junction. no evidence of a pneumothorax is present. the patient is status post cabg. the heart remains enlarged, no failure is present. brief hospital course: principle reason for admission 83 yo m with h/o mds and uretheral stricture with self-intermittent catheterizing admitted for with sepsis secondary to uti. active problems # sepsis secondary to urinary source: presented to ed with chills, abdominal pain and low grade fever. became hypotensive and had grossly positive ua in in setting of uretheral dilation for stricture and self-catheterization. patient was started on vancomycin and cefepime. received ivf's and blood transfusion with recovery of blood pressure. switched off vancomycin after gs showed no gram positive organism. culture grew pan-sensitive klebsiella and switched to ciprofloxacin to complete 15 day course. will complete 14 day course. # truction: patient followed by dr. as outpatient. underwent turp earlier this year for obstruction followed by dilation of urinary stricture in . has been self catheterizing at home since. foley was placed on admission. upon arrival to the floor, foley was removed with plan to bladder scan periodically and straigh cath as needed. patient did not tolerate plan as he complained of continuous 'leaking' with continued burning sensation. additional ua was obtained, which still showed large blood and wbc. culture pending at time of writing. after speaking with urology, chronic foley was placed until patient follows up with dr. as outpatient. # mds: previously treated with azacitidine, last dose 6/. did receive blood transfustion early in hospitalization. remained markedly thrombocytopenic during stay, but stable in low 20's. plan to continue follow up with outpatient oncologist. # relative hypocalcemia: noted to be hypocalcemic on admission to 6.5. albumin noted to be low at 2.4. ionized calcium normal at 1.14. by discharge total calcium recovered to 8.4. chronic problems # cad: stable, admission ekg showed no ischemic changes. home simvastatin was reduced from 80mg to 40mg. metoprolol was held in setting of hypotension, but restarted on discharge. patient was not treated with asa considering low platelets. # elevated alk phos: has been in 200's since . no u/s here in system. patient without ruq pain. deferred to outpatient setting. # depression: continued home mirtazapine and sertraline. # parkinsons: continued home carbidopa-levodopa. outstanding studies -urine cx from -final reports of blood cultures transitional issues -will need continued following for chronic urinary retention as patient did not tolerate intermittent self catheterization and currently has a chronic foley catheter. -please note simvastatin was reduced from 80mg to 40 mg. medications on admission: medications on transfer: docusate sodium 100 mg po bid @ 0035 sertraline 100 mg po/ng daily @ 0035 fluticasone propionate nasal 2 spry nu daily @ 0035 mirtazapine 30 mg po/ng hs carbidopa-levodopa (25-100) 1 tab po/ng tid multivitamins 1 tab po/ng daily @ 0035 vancomycin 1000 mg iv q 12h @ 0035 cefepime 1 g iv q24h @ 0035 acetaminophen 325-650 mg po/ng q6h:prn pain, fever @ 0035 simvastatin 40 mg po/ng daily @ 0035 potassium chloride replacement (oncology) iv sliding scale magnesium sulfate replacement (oncology) iv sliding scale phytonadione 5 mg po/ng once duration: 1 doses @ 1023 home medications: darbepoetin alfa 300 mcg/0.6 ml injection syringe 300mcg sc simvastatin 80 mg oral tablet sertraline 100 mg oral tablet amoxicillin 250 mg oral capsule take 1 capsule daily fluticasone 50 mcg nasal spray, susp nasal 2 spray,once daily metoprolol succinate er 25 mg 0.5 tablet once daily mirtazapine 15 mg tab oral 2 tablet(s) , at bedtime carbidopa-levodopa 25 mg-100 mg 1 tablet(s) 8 am, 12 noon, 4pm tylenol 325 mg tab oral 2 tablet(s) every 4-6 hrs, as needed one daily multivitamin tab oral 1 tablet(s) once daily discharge medications: 1. darbepoetin alfa in polysorbat injection 2. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 3. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 4. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 5. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 (one half) tablet extended release 24 hr po once a day. 9. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 days: take through . disp:*18 tablet(s)* refills:*0* discharge disposition: home with service facility: health vna discharge diagnosis: primary: sepsis due to a urinary source secondary: urinary retention, mds discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you were having chills, fevers, and abdominal pain. we found that you had a bad urinary tract infection and you went to the icu because your blood pressure was low. we treated you with antibiotics and your blood pressure recovered. you continued to have problems with urinary leakage, so after speaking with the urologists, we decided to leave a foley catheter in place until you can follow up with your urologist. please note the following changes to your medications. start: ciprofloxacin 500mg twice daily through decrease: simvastatin to 40mg daily stop: amoxicillin while taking cipro unless instructed otherwise by your urologist. it has been a pleasure taking care of you. followup instructions: the following appointments have been scheduled for you: department: oncology when: at 12 pm with: dr. location: address: , , phone: fax: department: surgical specialties when: monday at 1 pm with: , md building: campus: east best parking: garage md procedure: venous catheterization, not elsewhere classified diagnoses: acidosis hypocalcemia anemia, unspecified urinary tract infection, site not specified unspecified septicemia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status sepsis myelodysplastic syndrome, unspecified dysthymic disorder other and unspecified hyperlipidemia paralysis agitans other and unspecified coagulation defects other specified retention of urine hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (luts) urinary obstruction, not elsewhere classified 

Answer: The patient is high likely exposed to