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: codeine attending: chief complaint: abdominal pain major surgical or invasive procedure: ultrasound-guided paracentesis , and ir-guided nasogastric tube advancement history of present illness: ms. is a 54f with pmh of hcv and etoh cirrhosis (meld = 16) decompensated with esophageal varices and ascites requiring weekly paracentesis, multiple prior sbos, mesenteric ischemia s/p ex-lap/loa p/w abdominal distension and severe pain. . of note, patient has had several recent admissions to (, , , ). in early she was treated medically for an ileus which improved w/ time and npo. in early she was readmitted for abdominal pain and brbpr. after transient hypotension, she was admitted to the icu where her pressures improved after volume resussitation and transfusion of 2 units of prbc. flex sig demonstrated rectal varices without stigmata of recent bleeding, and grade 1 interal hemorrhoids were noted. her abdominal pain ultimately improved w/ time again and she was advanced to a solid diet prior to discharge. she was readmitted again several days later in w/ similar symptoms and again npo. a ct of the abdomen and pelvis during this hospitalization demonstrated again a small bowel obstruction with a transition point approximately in distal ileum presumed from adhesions. the sbo appeared worse than similar ct scan several weeks prior. as discharge summaries from two most recent hospital stays have not been completed, it appears her symptoms improved with w/ bowel rest and she was subsequently discharged. . per patient report, since discharge from , has had a 5d hospitalization at lgh for pain control of abdominal pain. during that time she underwent 2 paracentesis of 3l each, most recent being day prior to admission. she states she normally gets a paracentesis once/week at hospital, and then once/2 weeks at lgh, but lately, has been hospitalized so frequently she has not needed those outpatient appointments. patient reports that after discharge from lgh, abdominal pain worsened almost immediately. she describes pain as diffuse throughout her entire abdomen, worse around right flank and mid-abdomen. it's sharp, stabbing and constant. only relief is through pain meds; eating and bowel movements do not affect pain. she also reports associated nausea, but denies diarrhea/vomitting. she has been passing gas and having having regular bowel movements 3-4 times a day. the stools are soft, light brown, and no blood. she does note that during her recent stay at lgh, she had one black-colored stool that was not guaiaced. she denies fevers, chills, shortness of breath, chest pain. . of note she is scheduled for an elective admission to 10 on for inpatient nutrition c/s and dobhoff placement. patient states she has been eating high calorie foods per nutrition recommendations, but has been unable to gain weight. thus, malnutrition is most likely secondary to decreased gi absorption, possibly secondary to bowel edema. . in the ed, patient triggered for hypotension with initial vs hr100 sbp 87/69, which resolved without intervention. exam demonstrated moderately tender abd w/o rebound/guarding. labs were significant for creatinine 1.7 (baseline 1.0), mild transaminitis, tbili at baseline, lactate 2.0. she received 4mg of iv morphine for pain control. a diagnostic paracentesis was attempted by no ultrasound windows were visualized. liver was consulted who recommended admission to . vitals on transfer were: 97.9 85 102/78 14 99%ra. . on arrival to the floor, vital signs were 97.8 102/74 80 20 100%ra. patient reported abdominal pain, improved from prior, similar to prior admissions. . review of systems: denies fever, chills, night sweats, headache, cough, shortness of breath, chest pain, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: - hcv/etoh cirrhosis (dx ~; c/b ascites, esophageal varices s/p clipping x2, encephalopathy) - ckd - s/p ex-lap loa - s/p ex-lap/sbr x2 for perforation from blunt trauma - s/p laparoscopic tubal ligation social history: - tobacco: 30 pack/year history quit 5 years ago - etoh: 12 beer/day x 30 years quit 5 years ago - ivdu > 30 years ago - on disability, former surgical tech family history: not contributory to current hospitalization physical exam: admission physical exam: vs 97.8 102/74 80 20 100%ra general - cachectic, appearing older than stated age, no acute distress heent - dry mucous membranes, sclera anicteric, neck - supple, no jvd, no lad heart - rrr, nl s1-s2, no mrg lungs - ctab, no r/rh/wh abdomen - normoactive bs, distended with large hernia protruding above umbilicus, tympanic to percussion, mildly tender around the umbilicus, no rebound/guarding extremities - wwp, no edema, 2+ dp/radial pulses neuro - a&ox3, no asterixis . discharge physical exam: vs 98.3 (98.9) 125/72 (113-136/60-75) 98 (84-102) 20 100ra (96-100ra( weight 54.9 kg i/o po 2840 + iv 300 / brp, bmx4 general: very thin and cachetic female, looks older than stated age, comfortable. nad. heent: sclera icteric. perrl, eomi. clear oropharynx. neck: supple with low jvp cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, s1 s2 clear and of good quality without murmurs, rubs or gallops. no s3 or s4 appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use, moving air symmetrically. minimal expiratory wheezes diffusely, slightly shallow breathing. abdomen: normoactive bowel sounds. less distended, soft, non-tender. dullness to percussion over dependent areas but tympanic anteriorly. no hsm or tenderness. +foley. extremities: warm and well perfused, no clubbing or cyanosis. no edema, 2+ distal pulses. neuro: awake, alert and oriented x3. no asterixis. pertinent results: admission labs: 03:21am blood wbc-8.0 rbc-4.47 hgb-11.9* hct-38.3 mcv-86 mch-26.6* mchc-31.1 rdw-19.1* plt ct-125*# 03:21am blood pt-13.4* ptt-35.3 inr(pt)-1.2* 03:21am blood glucose-119* urean-38* creat-1.7* na-134 k-4.1 cl-101 hco3-24 angap-13 03:21am blood alt-47* ast-99* alkphos-296* totbili-1.7* 06:45am blood calcium-8.7 phos-3.7 mg-2.6 . relevant labs: 06:28pm blood type-art po2-182* pco2-22* ph-7.58* caltco2-21 base xs-1 intubat-not intuba 12:37pm blood type-art peep-5 fio2-40 po2-76* pco2-30* ph-7.45 caltco2-21 base xs--1 06:28pm blood lactate-2.1* 12:37pm blood lactate-2.1* 06:28pm blood freeca-1.17 12:37pm blood freeca-1.20 12:32pm urine color-dkamb appear-hazy sp -1.039* 09:36am urine color-amber appear-cloudy sp -1.028 12:32pm urine blood-mod nitrite-pos protein-30 glucose-neg ketone-tr bilirub-sm urobiln-2* ph-6.0 leuks-neg 09:36am urine blood-lg nitrite-pos protein-100 glucose-neg ketone-10 bilirub-sm urobiln-neg ph-6.0 leuks-lg 09:36am urine rbc->182* wbc->182* bacteri-many yeast-none epi-0 12:32pm urine mucous-many 09:36am urine wbc clm-few mucous-few 04:35pm ascites wbc-145* rbc-1480* polys-2* lymphs-51* monos-0 mesothe-2* macroph-45* 04:35pm ascites totpro-1.4 glucose-89 ld(ldh)-115 . discharge labs: 06:30am blood wbc-3.4* rbc-3.38* hgb-9.4* hct-30.4* mcv-90 mch-27.8 mchc-30.9* rdw-18.8* plt ct-84* 06:30am blood pt-17.1* ptt-48.4* inr(pt)-1.6* 06:30am blood glucose-103* urean-15 creat-0.9 na-139 k-4.1 cl-106 hco3-21* angap-16 06:30am blood alt-22 ast-40 alkphos-79 totbili-3.3* 06:30am blood calcium-9.0 phos-2.6* mg-1.9 . microbiology: blood cultures x2: no growth peritoneal fluid gram stain and culture: no growth hcv vl: 577,629 iu/ml. peritoneal fluid gram stain and culture: no growth blood cultures x2: no growth urine culture: no growth mrsa screen: no growth urine culture: klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | amikacin-------------- <=2 s ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- 2 s ceftazidime----------- 2 s ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- 128 r tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r . blood cultures x2: no growth sputum gram stain and culture: pmns, no growth on culture blood culture: no growth to date urine culture: klebsiella pneumoniae 10,000-100,000 organisms/ml sensitivities as above peritoneal fluid gram stain and culture: no growth . . imaging: chest (portable ap): findings: the tip of the endotracheal tube measures approximately 3.1 cm above the carina. patient has taken a slightly better inspiration. cardiac silhouette is within normal limits and there is no definite vascular congestion. there are areas of increased opacification at both bases. although this most likely reflects atelectasis, in the appropriate clinical setting, the possibility of supervening pneumonia would have to be considered. . portable abdomen: there has been interval improved number of small bowel loops that are distended consistent with improved partial small bowel obstruction. ng tube tip is in the stomach. there is evidence of ascites . chest (portable ap): there are low lung volumes. cardiac size is top normal. there are unchanged multiple bilateral right greater than left calcified granulomas. left lowerlobe opacity is likely atelectasis. there is no pneumothorax or pleural effusion. et tube is in standard position. ng tube tip is in the stomach. . paracentesis diag/therap w imaging guide: impression: uncomplicated bedside therapeutic and diagnostic paracentesis via a right flank approach. overall, the patient tolerated the procedure well with no early complications. . pelvis (ap only): impression: radiopaque pessary device is in place projecting over the pubic symphysis on single oblique frontal view. . portable abdomen: frontal abdominal chest radiograph demonstrates the ng tube terminates in the stomach. the small bowel is persistently dilated. there is little change from , . . portable abdomen: portable supine abdominal radiograph is little changed from 3:59 a.m. the abdomen is not completely imaged. the ng tube is no longer visualized. the small bowel is persistently dilated. . abdomen (supine/erect): supine and erect abdominal radiographs again demonstrate mild small bowel distention, worsened at 4:41 p.m. hernial orifices are not imaged. there is no pneumoperitoneum. pulmonary and mediastinal calcifications are partially imaged. impression: worsening small bowel distention. . ir-guided paracentesis: ultrasound-guided therapeutic and diagnostic paracentesis with removal of 7 l of clear, straw-colored fluid. brief hospital course: 54yo f pmhx hcv and etoh cirrhosis decompensated with esophageal varices and ascites requiring weekly paracentesis, multiple sbos, mesenteric ischemia s/p ex-lap/loa p/w abdominal distention and pain, found to have chronic partial small bowel obstruction, which was managed conservatively. hospital course was complicated by encephalopathy requiring intubation and micu admission, as well as klebsiella uti and . she ultimately left against medical advice. . . active issues: #chronic abdominal pain/sbo: patient had multiple prior admissions for chronic adbominal pain, thought to multifactorial due to chronic ascites, transient obstruction from adhesions/ileus, now presents with worsening of chronic pain. narcotic bowel syndrome was initially thought to be most likely diagnosis, given patient's hx of narcotic abuse and dependence, now trying to taper off narcotics to be listed for transplant. patient's sbo is likely contributing to acute nature of pain. patient then developed partial sbo, thus contributing to pain. patient was made npo and ngt was put to suction. chronic pain was consulted and recommended bupronorphine, which was not initially started out of concern for outpatient management of this drug. patient's tramadol and gabapentin were increased, lidoderm patch to back, and baclofen. sbo was followed by daily kub, abdominal exam, and lactate. while in the micu, transplant surgery was consulted, and recommended conservative management of partial sbo with ngt, along with po and pr lactulose. additionally, she had several therapeutic paracenteses for reflief of abdominal pressure from accumulating ascites. thereafter, she continued to have bowel movements and pass flatus. her diet was eventually advanced to regular. she had discontinued her ngt in the micu, and it was not replaced. . # encephalopathy: patient was appropriate late afternoon on , but found to be aggressive and encepahlopathic that night, pulled out ngt and piv. on morning of , was unresponsive, but vitals were stable. lactulose had been held for 7 days in the setting of sbo. at that time, there was no evidence of infection, as no sbp on paracentesis, no pneumonia on cxr, ua negative, and afebrile, no white count. ct head on am of showed no acute intracranial process. patient was transferred to the micu for concern of airway production as patient was becoming increasingly more confused in the context of being unable to take her lactulose and rifaxamin due to abdominal pain. she was transferred to the micu on , and intubated for airway protection rather than respiratory failure. she was extubated on prior to transfer for the floor. mental status improved with decompression of sbo, rifaxmin and lactulose. in the micu, she was noted to have a uti that was likely contributing to encephalopathy, ans she was started on ceftriaxone, while cultures were pending. cultures eventually returned with klebsiella resistant to ceftriaxone. patient was treated with one day of ceftazidime (to which the bacteria was sensitive) before she left ama. she was given a prescription for cefpodoxime to continue at home. . # klebsiella uti: as noted above, in the context of encephalopathy, patient was noted to have klebsiella uti. she was treated with one day of ceftazidime (to which the bacteria was sensitive) before she left ama. she was given a prescription for cefpodoxime to continue at home. it is unknown whether her klebsiella is sensitive to cefpodoxime, but the patient was willing to risk worsening of infection and possible sepsis/death by leaving the hospital. . # acute kidney injury: creatinine 1.7 on admission (baseline ranges from 0.8-1.1), which trended down to her baseline throughout admission. most likely, this was secondary to pre-renal azotemia from volume distribution with ascites, along with poor po intake from sbo/abdominal pain. several albumin challenges over the course of admission resulted in improved kidney function. . . chronic issues: #unspecified protein/calorie malnutrition: pt w chronically poor nutrition abdominal pain, albumin 3.1, many month period of poor po intake/weight gain. she appears cachectic, was planned for admission for dobhoff and tube feedings on a separate occasion. patient was given dobhoff (could not be advanced post-pyloric at ir), and tf were initiated based on nutrition consult, but stopped when patient developed sbo. patient cut dobhoff in half one night, hence it was pulled. current plan is to reinitiate tube feeds on another admission. . #gastritis: patient was continued on home omeprazole. . # cirrhosis: the patient has cirrhosis with multiple complications. she is on cipro at home for sbp prophylaxis. meld 10 today. she is not a transplant candidate at due to continued narcotic-seeking behavior. she was recommended to pursue transplant at another institution. . . transitional issues: # patient is not a liver transplant candidate at due to continued narcotic-seeking behavior. she was recommended to pursue transplant at another institution. # given prescription for cefpodoxime for klebsiella uti, although bacteria may not be sensitive to this medication. patient understood risks of leaving the hospital without full treatment of uti. # patient left ama. # code: full (confirmed) # contact: , daughter - medications on admission: - rifaximin 550 mg t.i.d. - thiamine 100mg daily - albuterol 90 hfa prn (patient states she does not take) - lasix 20 mg b.i.d. - omeprazole 40 mg b.i.d. - spironolactone 100 mg daily - cipro 500 mg daily - lactulose 30 ml t.i.d. - gabapentin 300 mg qhs discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po tid (3 times a day). 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 4. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 5. acetaminophen 500 mg capsule sig: one (1) capsule po every four (4) hours as needed for pain. 6. spironolactone 100 mg tablet sig: one (1) tablet po once a day. 7. lasix 20 mg tablet sig: one (1) tablet po twice a day. 8. lactulose 10 gram/15 ml (15 ml) solution sig: thirty (30) ml po three times a day. 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po once a day. 10. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day for 7 days. disp:*14 tablet(s)* refills:*0* 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). disp:*120 tablet, chewable(s)* refills:*0* discharge disposition: home discharge diagnosis: partial small bowel obstruction hcv/alcoholic cirrhosis type 2 hepatorenal syndrome malnutrition discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted with abdominal pain and found to have a partial small bowel obstruction. while you were here, we performed two paracenteses on your ascites, and found that you did not have an infection of your peritoneal fluid either time. we treated your obstruction with ngt to suction and keeping you with out food. eventually, we allowed you to slowly eat clear and then full liquids. we tried to initiate tube feeding during this admission, but this was complicated by your small bowel obstruction, so we were unable to initiate tube feeding at this time. we controlled your pain with tylenol, tramadol, gabapentin and flexeril, but you were not satisfied with this pain regimen. you had a urinary tract infection, with a bacteria (klebsiella) that was resistant to multiple antibiotics. it required treatment with intravenous ceftazidime, but you did not want to stay for this treatment. you understood that risks of stopping treatment included worsening of urinary tract infection, sepsis and death. we discharged you on an antibiotic that might work for the infection. please note that the following changes have been made to your medications: - start cefpodoxime 200 mg by mouth twice per day for seven days - start simethicone four times per day for abdominal pain you left against medical advice, but understood the risks of leaving the hospital. followup instructions: department: liver center when: wednesday at 2:40 pm with: , md building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage diagnoses: anemia, unspecified urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome unspecified protein-calorie malnutrition other, mixed, or unspecified drug abuse, unspecified chronic kidney disease, unspecified acute respiratory failure cachexia other ascites hyperosmolality and/or hypernatremia esophageal varices in diseases classified elsewhere, without mention of bleeding person feigning illness unspecified gastritis and gastroduodenitis, without mention of hemorrhage unspecified intestinal obstruction body mass index between 19-24, adult tubal ligation status 

Answer: The patient is high likely exposed to