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: no known allergies / adverse drug reactions attending: chief complaint: hypotension major or invasive procedure: none this hospitalization history of present illness: mr. is a spanish-comprehending 65m with complicated pmh including cva (nonverbal and does not move arms/legs at baseline), af on warfarin, h/o chronic aspiration and multiple pna (s/p trach/peg ), multiple prior episodes of uti/urosepsis with drug-resistant organisms (vre), c diff s/p colectomy, dm2, pvd, and several recent admissions for uti/sepsis, who presented to ed with blocked foley and elevated wbc, and became hypotensive. . the patient was discharged on after an admission for peg tube replacement. during this admission his foley catheter was replaced and proteus not treated as this was felt to be due to colonization. . in the ed, initial vs: t 97.6 hr 80 bp 96/76 rr 20 sat 94% 4l trach mask. wbc was 30, na 146, cr 1.6 from baseline of 0.4 and ua was markedly positive. however, he dropped his sbps to 70s, maps to 50s, improved with ivf. map 65, hr 69, o2 95% trach on 4l breathing on his own at 16. has a 20g in ej. dnr ok to vent. . in icu, initial bp in 130/70 but pt became hypotensive to 60-70s again. started on ivf and dopamine. additional pivs obtained. abx broadened to linezolid and cefepime. past medical history: * hypertension * hypothyroidism * h/o cva (bilateral embolic cerebellar , hemorrhagic left thalamic ) * type 2 diabetes mellitus * peripheral neuropathy * depression * h/o dvt (? - no records) * atrial fibrillation (on coumadin) * peripheral vascular disease * hyperlipidemia * tracheostomy and gj tube for chronic aspiration ()-portex bivono, size 6.0 * c.diff colitis in requiring total abdominal colectomy with end ileostomy , repeat positive c diff toxin (outside facility, here) social history: resident of nursing home, previously at . family very involved in care. patient does not take anything by mouth due to history of aspiration. spanish-speaking. patient is a former 60 pack year smoker but quit in . family history: patient has a mother with diabetes and brother with heart disease. physical exam: admission exam: . vitals: t: 97.7 (axillary) bp: 125/64 p: 58 r: 17 o2: 97% on trach 4l general: awake, non-verbal, no acute distress heent: sclera anicteric, mm dry, oropharynx clear. eyes looking up, pupils r>l but reactive to light bilaterally neck: trach in place with thick white secretions lungs: coarse breath sounds bilaterally, +scattered wheezing bilaterally, good air movement, respirations unlabored, no accessory muscle use heart: distant heart sounds but rrr, nl s1-s2, no r/m/g abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, peg and ostomy bags in place. gu: foley draining cloudy urine. ext: cold, palpable pulse on l dp, dopplerable pt on r, no edema. neuro: awake, non-verbal. no spontaneous movement of extremities. contracted arms bilaterally. . discharge exam: vs - t- afebrile, hr- 67-86 , bp- 120-130s/70s-80s , rr-20 , sao2- 96-99% ra general: non-verbal but can nod/shake head in response to questions heent: eomi and making good eye contact, sclera anicteric neck: , trach in place lungs: coarse breath sounds bilaterally, no wheezing, good air movement, respirations unlabored, no accessory muscle use heart: distant heart sounds but reg nl s1-s2, abdomen: soft but scar tissue palpated, non-tender, non-distended. peg in place. midline scar. no guarding or rebound tenderness or suprapubic tenderness extremities: warm, well-perfused, no edema, contractions. some mild bleeding at midline insertion site with pressure dressing placed. neuro: awake, non-verbal but can nod or shake head in response to y/n questions. cannot move legs or feet/toes; can move both arms slightly l>r (contracted hands b/l). pertinent results: admission labs: 06:10pm blood wbc-30.2*# rbc-5.64 hgb-13.4*# hct-40.0 mcv-71* mch-23.8* mchc-33.5 rdw-16.0* plt ct-222 06:10pm blood neuts-84.7* lymphs-10.9* monos-3.6 eos-0.2 baso-0.4 02:10am blood pt-29.0* inr(pt)-2.8* 06:10pm blood glucose-134* urean-50* creat-1.6*# na-146* k-4.9 cl-107 hco3-29 angap-15 . 07:01pm blood lactate-2.3* 10:47pm blood lactate-1.1 . 06:10pm urine color-yellow appear-cloudy sp -1.012 06:10pm urine blood-sm nitrite-pos protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-8.0 leuks-lg 06:10pm urine rbc-28* wbc->182* bacteri-many yeast-none epi-0 . microbiology: ucx : urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 8 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r bcx : no growth to date sputum cx: 10:00 am sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. . imaging studies: chest (portable ap) - in comparison with study of , there may be some mild engorgement with poor definition of lower lung vessels, suggesting some elevated pulmonary venous pressure. the right hemidiaphragm is more sharply seen, suggesting some improved aeration at the right base. patchy opacifications at the bases most likely reflect atelectasis, though in the appropriate clinical setting, supervening pneumonia would have to be considered. discharge labs/notable studies: 06:25am blood wbc-8.3 rbc-4.71 hgb-10.1* hct-32.3* mcv-69* mch-21.4* mchc-31.3 rdw-16.1* plt ct-183 06:25am blood pt-17.6* inr(pt)-1.7* 06:25am blood glucose-157* urean-15 creat-0.4* na-140 k-3.3 cl-104 hco3-28 angap-11 studies pending on discharge: none brief hospital course: 65 yo m with history cva c/b anoxic brain injury now nonverbal, paraplegic, bedbound, able to shake head and move upper extremities slightly, s/p trach/peg admitted with septic shock due to proteus urinary tract infection. #urinary tract infection/septic shock: patient was admitted with septic shock initially to the intensive care unit and was treated with broad spectrum abx including linezolid (for h/o vre) and cefepime and required dopamine for vasopressor support along with ivf rescucitation. his symptoms improved and he was transferred to the floor. his urine cultures grew proteus sensitive to ceftriaxone and his antibiotics were narrowed to ceftriaxone alone to be continued for a 2 week course for complicated uti. # trach/respiratory: patient had some thick secretions but cxr showed no pneumonia and he did not have hypoxia. duonebs were given prn. #acute renal failure: patient found to have elevated creatinine to 1.6 which improved to baseline 0.4-0.7 with treatment of sepsis. # hypernatremia: mild, likely in setting of hypovolemia/dehydration, improved with hydration/free water. . #type 2 diabetes mellitus: patient on insulin as outpatient. his blood blood glucose was monitored and he was continued on home and humalog ssi. . # depression/leg pain: duloxetine and mirtazapine were initially held due to concern of interaction with linezolid. patient did experience increased leg pain with these held. these were restarted when renal function improved and linezolid was discontinued and pain symptoms improved. . # atrial fibrillation: patient was continued on coumadin. inr was therapeutic except for day of discharge (1.7). this should be followed by nh. . chronic issues: # hypothyroidism: continue levothyroxine 25 mcg daily by ng tube . # spasticity: continue baclofen 15 mg qid . # c.diff colitis in requiring total abdominal colectomy with end ileostomy - colostomy care . # peripheral neuropathy: continued gabapentin 300 mg q8hrs . # fen: npo. tube feeds # prophylaxis: systemic anticoagulation with coumadin # access: midline left upper extremity # communication: ( (cell); (day); (eve), son/hcp # code: dnr, ok to use trach (discussed with the hcp) # disposition: patient was discharged to his nh to complete treatment for proteus uti to end . inr should be monitored as inr was 1.7 on day of discharge. medications on admission: - acetaminophen 650 mg/20.3 ml solution, by mouth every six (6) hours as needed for pain. - ascorbic acid 500 mg/5 ml syrup, five (5) ml by mouth twice a day. - baclofen 10 mg tablet 1.5 tablets by mouth four times a day. - bisacodyl 10 mg suppository, one (1) suppository rectal hs (at bedtime) as needed for constipation. - docusate sodium 50 mg/5 ml liquid, ten (10) ml by mouth twice a day as needed for constipation. - duloxetine 30 mg capsule, delayed release(e.c.) one (1) capsule, delayed release(e.c.) by mouth daily (daily). - fentanyl 100 mcg/hr patch 72 hr one (1) patch 72 hr transdermal every seventy-two (72) hours. - furosemide 20 mg tablet one (1) tablet by mouth daily (daily). - gabapentin 300 mg capsule one (1) capsule by mouth every eight (8) hours. - insulin aspart 100 unit/ml solution sliding scale subcutaneous four times a day. - insulin glargine 100 unit/ml solution thirty two (32) units subcutaneous at bedtime. - ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization one (1) inhalation every 4-6 hours as needed for shortness of breath or wheezing. - lansoprazole 30 mg tablet,rapid dissolve, dr (1) tablet,rapid dissolve, dr mouth once a day. - levothyroxine 25 mcg tablet one (1) tablet by mouth daily (daily). - magnesium hydroxide 400 mg/5 ml suspension thirty (30) ml by mouth once a day. - mirtazapine 15 mg tablet one (1) tablet by mouth hs (at bedtime). - morphine 10 mg/5 ml solution ten (10) mg by mouth every six (6) hours as needed for pain. - sennosides 8.6 mg tablet one (1) tablet by mouth twice a day as needed for constipation. - therapeutic multivitamin liquid one (1) tablet by mouth daily (daily). - warfarin 2 mg tablet two (2) tablet by mouth once daily at 4 pm. - zinc sulfate 220 mg capsule one (1) capsule by mouth daily (daily). discharge medications: 1. acetaminophen 650 mg/20.3 ml solution : one (1) po q6h (every 6 hours) as needed for pain/fever. 2. ascorbic acid 500 mg/5 ml syrup : one (1) po bid (2 times a day). 3. baclofen 10 mg tablet : 1.5 tablets po qid (4 times a day). 4. bisacodyl 10 mg suppository : one (1) suppository rectal twice a day as needed for constipation. 5. duloxetine 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily): please give via gt. 6. fentanyl 100 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 7. gabapentin 300 mg capsule : one (1) capsule po tid (3 times a day). 8. insulin aspart 100 unit/ml solution : as directe subcutaneous every six (6) hours: according to sliding scale. 9. insulin glargine 100 unit/ml solution : thirty two (32) units subcutaneous at bedtime. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) nebs inhalation q6h (every 6 hours) as needed for wheezing/shortness of breath. 11. ipratropium bromide 0.02 % solution : one (1) nebs inhalation q6h (every 6 hours) as needed for wheezing/shortness of breath. 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. furosemide 20 mg tablet : one (1) tablet po daily (daily). 14. mirtazapine 15 mg tablet : one (1) tablet po hs (at bedtime). 15. morphine 10 mg/5 ml solution : five (5) ml po q6h (every 6 hours) as needed for pain. 16. warfarin 2 mg tablet : two (2) tablet po once daily at 4 pm. 17. zinc sulfate 220 mg capsule : one (1) capsule po daily (daily): continue until . 18. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. 19. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 20. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 21. ceftriaxone 1 gm iv q24h duration: 7 days to end discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: primary: sepsis urinary tract infection secondary: prior stroke type 2 diabetes mellitus acute renal failure discharge condition: mental status: clear and coherent. (nonverbal but understands and able to communicate with head nodding) level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: you were admitted for sepsis due to a urinary tract infection. you improved with antibiotics and are being discharged on a two week total course of antibiotics to end . your pain medications were initially held, but were restarted prior to discharge once your renal function and blood pressure returned to . followup instructions: department: specialties when: thursday at 12:00 pm with: pelvic floor unit building: sc clinical ctr campus: east best parking: garage department: care unit when: friday at 8:30 am building: de building ( complex) campus: west best parking: garage department: when: friday at 10:00 am with: west building: cc clinical center campus: west best parking: garage procedure: enteral infusion of concentrated nutritional substances diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism atrial fibrillation polyneuropathy in diabetes depressive disorder, not elsewhere classified septic shock long-term (current) use of anticoagulants pressure ulcer, lower back other septicemia due to gram-negative organisms hyperosmolality and/or hypernatremia tracheostomy status diabetes with neurological manifestations, type ii or unspecified type, uncontrolled pressure ulcer, stage ii late effects of cerebrovascular disease, speech and language deficit, unspecified 

Answer: The patient is high likely exposed to