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: patient recorded as having no known allergies to drugs attending: chief complaint: dehydration, uti major surgical or invasive procedure: none history of present illness: mr. is a 66 yom with supranuclear palsy and chronic contractures living at center of , who was brought to the ed after routine labs showed elevated na to 152 and cr bump. this is in the background of several weeks of poor po intake, and he is being considered for a feeding tube. he is non-verbal, moans and is contracted at baseline, and has severe constipation problems requiring manual disimpaction at his last admission. . the patient was recently admitted from - 28/10 for arf (mixed pre-renal and obstructive from unclear etiology), left hydronephrosis with forniceal rupture, and left nephrostomy placement. he was then readmitted on admitted from - for removal of left nephrostomy tube under ir guidance; on that admission, he was found to have a massively dilated bladder and had developed a right hydroureter. he was given a voiding trial overnight after his foley was pulled prior to discharge; he failed and was discharged with instructions for tid straight caths. the etiology of his urinary retention remains uncertain but may be related to his snp and he was also started on terazosin after ct showed an enlarged prostate. of note, urine cultures from these admissions were negative. per family foley was last changed on , but i am not certain when a foley catheter was initially placed after his last discharge. . in the ed, vs were t 99.2, p 83, bp 126/74, rr 18, o2 100%. he received 6l ns for concern for sepsis and hypotension (lowest bp 95/65 with hr 78). bp on discharge from last admission was 107/77 and his sbp was noted to run 100-140's. he received iv levofloxacin for uti. . past medical history: 1. supranuclear palsy, non-verbal, followed by dr. at . has progressively been declining 2. dementia 3. hld 4. s/p tkr and shoulder surgery 5. recent admission from after p/w arf (pre-renal and obstructive), left hydronephrosis c/b forniceal rupture (had 2 days iv abx), and nephrostomy placement (was capped prior to discharge with plan to remove in 1 week). social history: previous lived with wife prior to admission who provided all his care with help of his children. now cared for in a nursing home. used to work on the , now on disability. family history: non-contributory physical exam: vs: 97.3, 132/84-89, 60s, 18-20@100%(ra) general: thin and chronically ill appearing; occasional moaning; non verbal heent: poor dentition, atraumatic, perrla, eom difficult to assess lungs: seemingly ctab (anteriorly), but unable to cooperate cardio: rrr, no murmurs appreciated abd: + bs, soft, nd, nt skin: sacral decub over coccyx, stage 4 ext: wwp, no cyanosis or clubbing. trace le edema. distal pulses radial 2+, dp 2+. neuro: non-verbal. minimal tracking to voices. occasionally follows commands to squeeze fingers or open mouth. withdraws to pain. pertinent results: admission labs: 06:30pm blood wbc-9.3 rbc-3.96* hgb-10.8* hct-34.5* mcv-87 mch-27.4 mchc-31.4 rdw-15.1 plt ct-213 06:30pm blood neuts-78.3* lymphs-18.4 monos-2.5 eos-0.6 baso-0.2 06:30pm blood pt-13.0 ptt-27.9 inr(pt)-1.1 06:30pm blood glucose-114* urean-32* creat-0.8 na-153* k-3.8 cl-114* hco3-28 angap-15 04:24am blood albumin-2.5* calcium-7.1* phos-2.3* mg-1.9 06:56pm blood lactate-2.8* 05:37am blood lactate-1.6 urinalysis: 12:04am urine color-yellow appear-clear sp -1.031, blood-mod nitrite-pos protein-25 glucose-1000 ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-mod, rbc-* wbc-21-50* bacteria-many yeast-none epi-0-2, urine casthy-* microbiology: blood cultures: ngtd urine cultures: urine culture (final ): escherichia coli. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ 8 i trimethoprim/sulfa---- <=1 s c diff: negative imaging: ct abd/pelvis with contrast: 1. interval removal of left nephrostomy tube. no evidence of hydronephrosis. multiple large renal cysts bilaterally could mimic appearance of hydronephrosis in non-contrast study. 2. interval development of decubitus ulceration in the midline sacrococcygeal region. small pocket of subcutaneous fluid and air. concerning for developing osteomyelitis and/or abscess. recommend direct inspection of the affected area. 3. moderate fecal loading. no evidence of colitis. admission cxr: no evidence of pneumonia. discharge labs: 10:10am blood wbc-3.8* rbc-3.72* hgb-10.2* hct-31.2* mcv-84 mch-27.4 mchc-32.6 rdw-14.7 plt ct-195 05:48am blood glucose-93 urean-2* creat-0.4* na-138 k-3.7 cl-107 hco3-26 angap-9 05:48am blood albumin-2.6* calcium-8.4 phos-2.4* mg-1.9 brief hospital course: mr. is a 66 yo man with supranuclear palsy and end stage dementia with worsening po intake over last few weeks, new large sacral decub ulcer and uti/urosepsis, admitted to the micu for acute management of hypernatremia. . #. hypernatremia: the patient has poor po intake over the last few weeks while at rehab with progression of his underlying neurologic disease and inability to swallow. sodium of 153 on admission corrected with aggressive fluid rehydration in the icu. regarding future hydration and nutrition, multiple family meetings were held in order to evaluate goals of care. electrolytes were trended throughout the hospitalization, and no further hypernatremia was noted. iv fluids were given as necessary. . #. goals of care: pt has had poor po intake for months, and acutely worsened over last few weeks. pt initially admitted with intention of peg placement, though with expressions of desire for "comfort care," peg placement was postponed. palliative care was consulted, and first family meeting addressed decubitus ulcer and malnutrition. following this first meeting, these topics were addressed further while team attempted to better define family's goals of care. even though patient's family is not pursuing strict cmo measures at this point, they have the patient's comfort in mind. it is for these reasons that the patient's family ultimately decided to pursue a peg placement, as they feel that state of dehydration is uncomfortable to patient. the family struggles with feeling of "abandoning " patient, and feel that to not hydrate and/or feed is abandoning patient. they are very educated on patient's prognosis, and are not pursuing feeding tube in effort to extend lifespan. . #. malnutrition with albumin of 2.5, decreased po intake: difficult to fully assess given pt's baseline non-verbal state from snp, but snp and end-stage dementia likely contributing. speech/swallow saw patient and determined that pt should be npo except ice chips and evaluate for other means of nutritional supplementation. gi was consulted after numerous meetings regarding goals of care, and pt had peg placed on . post-peg check was within normal limits, and water flushes and nutrition started on . while not taking any nutrition, bowel regimen was on hold. will need to re-evaluate after patient at goal tf intake. . #. uti, urosepsis: pyruia on admission ua, in context of hypotension. elevated lactate at admission --> tissue hypoperfusion. given pt's past medical history, he was started empirically on ceftriaxone for uti. blood cultures were negative and he was hemodynamically stable with ivf, never needing pressors in the icu. pt was called out of the micu on , and completed his antibiotic course on the floor. urine cultures grew e. coli sensitive to ceftriaxone, and pt completed a 7-day course. . #. sacral decub ulcer: pt had a large sacral decubitus ulcer that was managed by the wound nurse. it did probe to bone, though he was not started on antibiotics for osteomyelitis given goals of care. medications on admission: (per recent discharge summary): 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. polyethylene glycol 3350 17 gram/dose powder sig: two (2) packets po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 5. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 6. dulcolax 10 mg suppository sig: one (1) rectal once a day as needed for constipation. 7. milk of magnesia 400 mg/5 ml suspension sig: thirty (30) ml po once a day as needed for constipation. 8. fleet enema 19-7 gram/118 ml enema sig: one (1) rectal once a day as needed for constipation. 9. tylenol 325 mg tablet sig: 1-2 tablets po three times a day. 10. bisacodyl 10 mg/30 ml enema sig: one (1) rectal once a day as needed for constipation. discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. morphine 100 mg/4 ml solution sig: 1-2 mg intravenous with wound dressing changes as needed for pain. discharge disposition: extended care facility: highgate manor discharge diagnosis: primary: -urinary tract infection -malnutrition, severe -hypernatremia secondary: -supranuclear palsy -dementia discharge condition: level of consciousness: lethargic but arousable. activity status: bedbound. mental status: confused - always. at baseline, patient does not interact; occasionally groans and tracks to voice. discharge instructions: mr. , you were hospitalized at with decreased oral intake and malnutrition, high sodium levels in your blood (hypernatremia), and a urinary tract infection. while you were here, we had our speech/swallow therapists see you, and they observed that it was very dangerous for you to have anything (liquid or food) orally. we treated your urinary tract infection with iv antibiotics, gave you fluids through an iv, and addressed your nutrition status with your loving family members. had a peg tube placed for nutrition/hydration needs. we had several family meetings addressing your care, and you are being discharged to a skilled nursing facility. the following changes were made to your medications: -stop all medications that you used to take orally: docusate, miralax, multivitamin, tamsulosin, senna, milk of magnesia, oral tylenol. if these medications are to be continued, they will have to be given via your peg tube. -you can resume suppository and enema medications to help with bowel movements after having tube feeds for >24-48 hours followup instructions: per family desire; can call to schedule appointments. md procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: urinary tract infection, site not specified other and unspecified hyperlipidemia pressure ulcer, lower back other constipation hyperosmolality and/or hypernatremia aphasia other specified paralytic syndrome pressure ulcer, stage iv nutritional marasmus spasm of muscle unspecified persistent mental disorders due to conditions classified elsewhere 

Answer: The patient is high likely exposed to