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: aspirin / toradol / neurontin attending: chief complaint: tracheal stenosis major surgical or invasive procedure: rigid bronchoscopy, flexible bronchoscopy, balloon dilatation x2. cervical tracheal resection and reconstruction, suprahyoid release. flexible bronchoscopy history of present illness: the patient is a 63 y/o male who is transferred from osh for treatment of tracheal stenosis revealed on ct scan. the patient was originally admitted to the osh in with obesity hypoventilation syndrome. during that admission, he had a tracheostomy secondary to ventilator dependence. he was discharged to rehab where he was weaned off the vent and was eventually decannulated and discharged to home shortly prior to . over the previous week, he has had increasing shortness of breath and has been complaining of saliva getting stuck in his upper airway. he represented to the osh where he was started on steroids with improvement of his symptoms. the patient has had cough productive of clear sputum. the patient otherwise denies fever, chills, nausea/vomiting, chest pain, or hemoptysis. past medical history: 1. obesity 2. iddm 3. htn 4. obstructive sleep apnea 5. restrictive lung disease 6. chronic venous stasis 7. rectal abscess 8. nasal polyposis 9. elevated r hemidiaphragm due to mva 10. pfo social history: the patient is married, lives with his wife. has two children. he owns five restaurants. he is half greek half albanian. he smoked for several years and admittedly denies alcohol use. he quit smoking in . family history: father had a pacemaker and irregular heart rate and question of diabetes, mother history of kidney cancer and had one kidney removed. there is no history of premature coronary artery disease in the family. physical exam: t 98.2 p 118 bp 148/90 r 24 sao2 91% ra gen - alert and oriented x3, no acute distress, pupils equal round and reactive to light, extraocular muscles intact heent - neck supple, no cervical lymphadenopathy, no carotid bruits lungs - diminished breath sounds bilaterally, no wheezes heart - regular rate and rhythm, i/vi systolic ejection murmur abd - obese, soft, nontender, nondistended, bowel sounds auscultated extrem - chronic venous stasis with hyperpigmentation in bilateral lower extremities pertinent results: 09:20pm blood wbc-18.9* rbc-4.73 hgb-13.9* hct-42.3 mcv-89 mch-29.3 mchc-32.8 rdw-16.0* plt ct-225 09:20pm blood pt-11.6 ptt-20.5* inr(pt)-1.0 09:20pm blood glucose-419* urean-35* creat-1.2 na-137 k-5.2* cl-96 hco3-30 angap-16 09:20pm blood phos-3.9 mg-2.0 09:03pm urine blood-neg nitrite-neg protein-neg glucose-1000 ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 09:03pm urine color-straw appear-clear sp -1.026 8:19 pm sputum site: endotracheal source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): oropharyngeal flora absent. escherichia coli. moderate growth. trimethoprim/sulfa sensitivity testing available on request. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. serratia marcescens. 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. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | serratia marcescens | | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- r <=1 s ceftazidime----------- =>64 r <=1 s ceftriaxone----------- r <=1 s cefuroxime------------ r ciprofloxacin--------- =>4 r <=0.25 s gentamicin------------ <=1 s <=1 s imipenem-------------- <=1 s <=1 s levofloxacin---------- =>8 r <=0.25 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- r <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s 4 s brief hospital course: the patient was admitted and had an airway ct which showed high-grade focal tracheal stenosis at level of the cervicothoracic junction, corresponding to a site of prior tracheostomy tube insertion. coronal narrowing to 6 mm at end inspiration, with component of airway malacia at end expiration, with further narrowing to 3 mm. the patient was continued on steroids because it had helped with his respiratory distress. the patient also had an echocardiogram which was negative for patent foramen ovale or atrial septal defect and showed preserved left ventricular systolic function. the patient went to the or for a rigid bronchoscopy and balloon dilatation, however the stenosis was unable to be dilated. the patient went to the or for trachel reconstruction which he tolerated well. the patient was kept sedated and intubated to allow the tracheal reconstruction to heal. broad spectrum antibiotics were started for empiric therapy. a dobhoff tube was placed for tube feeds. lovenox was started because the patient was considered high risk for dvt. the patient also developed brief runs of atrial fibrillation which was well rate controlled with beta blockers. the patient had bilateral patchy infiltrates on chest x-ray, grew e. coli and serratia from his sputum cultures, and received a bronchoscopy for therapeutic aspiration on and . the patient was able to be extubated on . the patient self d/c'd his dobhoff tube and was started on tpn. fortunately, he was able to pass his swallow evaluation and his diet was gradually advanced. the patient was transferred to the floor on . physical therapy was consulted to assist the patient with his ambulation. at discharge, the patient was able to tolerate a regular diet and his pain was well controlled. he will continue with a steroid taper. from a respiratory standpoint, the patient had good oxygen saturations with supplemental oxygen via 4 liters nasal canula. medications on admission: 1. prednisone 30'' 2. ativan 3. trazadone 4. lisinopril 5. combivent 6. flonase 7. metoprolol 25'' 8. protonix 40 9. tamsulosin 0.4 10.lantus 35u 11. pregabalin 50''' discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 2. furosemide 20 mg iv bid 3. prednisone 5 mg tablet sig: two (2) tablet po daily (daily). 4. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed. 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day) as needed. 8. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. 9. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 10. enoxaparin 40 mg/0.4 ml syringe sig: forty (40) mg subcutaneous q12h (every 12 hours). 11. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 12. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 13. pregabalin 50 mg capsule sig: one (1) capsule po three times a day. 14. enoxaparin 100 mg/ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 15. regular insulin sliding scale per finger stick discharge disposition: extended care facility: northeast - discharge diagnosis: tracheal stenosis discharge condition: stable discharge instructions: call your doctor or seek immediate medical attention if you experience fever, chills, lightheadedness, dizziness, chest pain, shortness of breath, wheezing, palpitations, abdominal pain, nausea/vomiting, or increased drainage, redness, or bleeding from surgical wound. no driving while taking pain medications. no tub baths or swimming. no heavy lifting for one month. diet as tolerated. you may use dry dressing to cover wound. followup instructions: you have a follow up appointment with dr. on 10am on clinical center . this d/c summary was completed by dr. and signed by np procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation other intubation of respiratory tract fasciotomy closed [endoscopic] biopsy of bronchus other repair and plastic operations on trachea other operations on trachea diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) pneumonia due to other gram-negative bacteria unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) long-term (current) use of insulin pneumonia due to escherichia coli [e. coli] obesity, unspecified disorders of diaphragm venous (peripheral) insufficiency, unspecified other diseases of trachea and bronchus 

Answer: The patient is high likely exposed to