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: meropenem / penicillins attending: chief complaint: gi bleed. major surgical or invasive procedure: transfusion of one unit of packed red blood cells colonoscopy history of present illness: mr. is an 83 year old male with past medical history of atrial fibrillation, esrd on hd, history of gastrointestinal bleeding, . . today, while at rehabilitation at , he was noted to have several bowel movements with bright red blood and clots, at least three witnessed episodes of about 200 cc total. around that time, his systolic blood pressure was reported to be in the 70's. he was given 1000 cc of ns prior to transfer. he initially presented to , where he received one unit of prbc's and two liters of ivf. his hct there was found to be 26.7. . in the ed, initial vital signs were notable for a blood pressure of 89/52. at time of arrival to , he had received four liters of ivf. ng placement for lavage was attempted, however patient refused. while in the ed at , he had no further episodes of bleeding, however rectal exam was notable for bright red blood. due to concerns over some possible guarding, at ct abdomen was completed. gi was consulted from the ed as well. in the ed, he received one unit of prbc and 500 cc of ns. . he also received 1 gram of vancomycin, 400 mg of iv ciprofloxacin, and 500 mg of iv flagyl after his urine was noted have an appearance "of pus." . on the floor, he reports that he feels "okay," and has no complaints. past medical history: - esrd on hd tuesday/thursday/saturday - atrial fibrillation, not on anticoagulation - h/o gi bleeds, diverticulitis - c. diff colitis - h/o cvas (two, with residual right-sided weakness) - h/o nephrolithiasis w/ stent and nephrostomy tube - cad s/p mi - sleep apnea (not on cpap) - depression - pft's with mild restrictive ventilatory defect - anemia with h/o iron deficiency - recent fall with c2 dens fracture with anterior displacement () - numerous line infections, most recently mrsa which was treated with vancomycin until (also with mrsa , esbl e. coli , , , and ) - delirium during hospital admissions - copd and restrictive lung disease - common bile duct stone s/p stenting - urinary tract infections, including vre and klebsiella, with urosepsis social history: patient recently has been at rehabilitation since fall and c2 fracture. lives with wife , daughter lives downstairs, h/o smoking ppd for 50 years, quit 20 years ago, occasional beer, none recently, no drugs. family history: non-contributory. physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 04:00pm pt-14.5* ptt-34.1 inr(pt)-1.3* 04:00pm plt count-252 04:00pm neuts-86.3* lymphs-9.3* monos-3.6 eos-0.7 basos-0.2 04:00pm wbc-10.8 rbc-3.21* hgb-9.4* hct-30.4* mcv-95 mch-29.4 mchc-30.9* rdw-18.8* 04:00pm albumin-2.3* calcium-8.7 phosphate-2.6*# magnesium-1.8 04:00pm ctropnt-0.04* 04:00pm alt(sgpt)-6 ast(sgot)-13 ld(ldh)-129 alk phos-116 tot bili-0.4 04:00pm estgfr-using this 04:00pm glucose-92 urea n-27* creat-3.4*# sodium-137 potassium-3.6 chloride-103 total co2-24 anion gap-14 04:08pm lactate-0.7 05:50pm urine rbc-* wbc->50 bacteria-many yeast-none epi-0-2 05:50pm urine blood-lg nitrite-neg protein->300 glucose-neg ketone-15 bilirubin-neg urobilngn-0.2 ph-6.0 leuk-lg 05:50pm urine color-amber appear-cloudy sp -1.025 microbiology: - blood culture - no growth - blood culture - no growth - urine culture - klebsiella oxytoca klebsiella oxytoca sensitivities: ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 2 i gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s imaging/studies: ecg : baseline artifact. sinus versus ectopic atrial rhythm. borderline p-r interval prolongation. left axis deviation. consider left anterior fascicular block of right bundle-branch block type. since the previous tracing of the rate is slower and the axis is less left superior. the qrs complex is narrower. st-t wave abnormalities are improved. cxr : findings: portable ap view of the chest was obtained. a dialysis catheter is again noted with its tip in the region of the superior vena cava. there is a vascular stent traversing the left brachiocephalic vein. low lung volumes limit the evaluation. cardiomegaly is again noted with scattered bilateral reticular lung opacities, which appear grossly stable compared with multiple prior exams. possibility of mild congestion cannot be entirely excluded, though there is no overt chf. a small left-sided pleural effusion cannot be excluded as well. mediastinal contour is grossly stable. no pneumothorax is seen. bony structures are unchanged with degenerative changes of the left shoulder and right humeral head prosthesis. degenerative changes are also noted in the spine. impression: cardiomegaly, possible mild fluid overload. ct abdomen/pelvis : impression: 1. no evidence for mesenteric ischemia. 2. colonic diverticulosis, without evidence for diverticulitis. 3. stable focal dissections in distal abdominal aorta and left common iliac extending in to the proximal left external iliac artery. stable fusiform aneurysm of the left common iliac artery. 4. thickened bladder wall. correlate clinically with evidence of urinary tract infection. 5. heterogeneous renal enhancement, compatible with multiple small renal cysts in the setting of hemodialysis, unchanged from prior study. 6. nodular liver again suspicious for cirrhosis. stable pneumobilia suggesting prior biliary intervention. colonoscopy : severe diverticulosis brief hospital course: mr. is an 83 year old male with past medical history of esrd on hd, atrial fibrillation, hd line infections, and prior gi bleeds who presented with bright red blood per rectum. #) bright red blood per rectum: concerning for lower gi bleed (though cannot exclude upper source), given history of similar episodes in past. last colonoscopy was , at which time diverticulosis was seen along with an abnormal patch of mucosa in the rectum and a rectal polyp. egd in was normal. differential included repeat diverticular bleed, avm, malignancy, among other causes. ng lavage refused by patient. the patient received 1 unit of prbcs on arrival, with subsequent stabilization in hct to ~30. iv ppi was started, 2 large bore ivs placed. gi team was consulted, and did not see any urgent need to scope. the patient was transferred to the medicine floor. spine consult was called prior to egd, with recommendation for keeping head in neutral position throughout procedure. colonoscopy was performed which revealed severe diverticulosis which was deemed causative factor for bleed and egd therefore not indicated. hct trend stable at time of discharge. #) esrd: received hd while an inpatient. there was initial concern for fluid overloaded state given all 4l ivf given on the floor and 2 units of prbc's that he received. he was taken to hd on (instead of usual ). he was continued on nephrocaps, calcium acetate, midodrine prior to dialysis, and darboetin weekly. last hd was on morning of discharge, with plan to resume hd on tuesday, thursday, saturday schedule. #) history of recurrent uti's: urine analysis on arrival was concerning for infection. he has a history of numerous pathogens that are resistent (vre, esbl klebiella). he received vanco/cipro/flagyl in ed, and was continued on cipro/daptomycin in micu while awaiting culture data; culture grew sensitive klebsiella oxytoca. he was started on a 7 day course of bactrim. he had no fever, hypothermia, or leukocytosis to suggest sirs/sepsis (initial hypotension was attributed to bleeding episodes). #) atrial fibrillation: not on anticoagulation for history of bleeding. rate well controlled. #) coronary artery disease: aspirin was initially held, then restarted once hct became stable just prior to micu callout. #) hyperlipidemia: atorvastatin continued. #) access: picc line placed #) contact: wife - home (, cell ( #) code: full (discussed with patient) medications on admission: (per documentation from spaudling) - acetaminophen 975 mg tid - asa 81 mg - atorvastatin 10 mg - calcium acetate 1334 mg tid - ciprofloxacin 250 mg after hemodialysis - cyanocobalamin 100 mcg daily - darbepoetin alfa 200 mcg qwednesday - ferrous sulfate 325 mg daily - miconazole powder - midodrine 10 mg m/w/f 1 hour prior to dialysis - nephplex tablet daily (nephrocap) - omeprazole 20 mg daily - tiotropium 10 mcg daily - tramadol 25 mg - trazodone 25 mg qhs - oxycodone 2.5 mg prior to pt - albuterol nebulizer prn - docusate 100 mg - polyethylene glycol 17 grams prn - senna prn discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily (daily). 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 4. midodrine 5 mg tablet sig: two (2) tablet po tues-thurs-sat: gibe one hour prior to dialysis. 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: inhalation q6h (every 6 hours) as needed for shortness of breath. 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 days: please take medication through to complete treatment for uti. disp:*4 tablet(s)* refills:*0* discharge disposition: extended care facility: nursing home - discharge diagnosis: primary: - gastrointestinal bleed - hypotension - urinary tract infection secondary: - end-stage renal disease on dialysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were transferred to after several episodes of rectal bleeding. you received 1 unit of blood after your arrival, and your blood levels stabilized. you were seen by the gastroenterology service, and underwent a colonoscopy which showed extensive diverticulosis. a urine test showed evidence of infection, so you were started on antibiotics. a hepatitis panel was checked for you before your return to our outpatient dialysis unit which was all negative. we have made the following changes to your medication regimen: - began taking bactrim for uti. you will continue to take this medication for a total of 7days with the last day being . please continue to take your medications as prescribed. followup instructions: department: when: monday at 1:30 pm with: , md building: (, ma) campus: off campus best parking: free parking on site md, procedure: venous catheterization, not elsewhere classified hemodialysis closed [endoscopic] biopsy of large intestine diagnoses: end stage renal disease renal dialysis status anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site chronic airway obstruction, not elsewhere classified atrial fibrillation depressive disorder, not elsewhere classified other and unspecified hyperlipidemia old myocardial infarction hemorrhage of gastrointestinal tract, unspecified diverticulosis of colon (without mention of hemorrhage) anal and rectal polyp 

Answer: The patient is high likely exposed to