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 drug allergy information on file attending: chief complaint: abdominal pain, fever major surgical or invasive procedure: ercp history of present illness: mr. is a 78 yo m with pmh cad, h/o hemolytic anemia who presented to on with abdominal pain, fevers, chills. according to osh records he reported having right upper quadrant abdominal pain has been present intermittently for several months. in addition he was reporting diarrhea for 2 days prior to presentation. he denied any chest pain, nausea, vomiting, dizziness. . in he had temperatures to 103, bp 88/49, 90% nc. exam notable for epigastric and periumbilical tenderness and rebound. labs notable for t.bili of 3.6, direct 1.8, wbc 8.2, 17,000 bands. ct scan showed thickened gall bladder wall, otherwise normal. he was treated for acute cholecystitis and sepsis with ivf, zosyn, levophed and vasopressin. he was intubated when he became agitated, hypoxic and cyanotic. he was seen by surgery who felt he was too ill for surgical intervention, so he had percutaneous cholecystostomy tube placement by ir. preliminary bile fluid analysis showed gram negative bacilli. he also developed acute renal failure which was felt to be atn by renal consult service. he was weaned off levophed by with stable bp and hr. he had elevated troponins and was seen by cardiology service who felt this was due to demand ischmia. patient was transferred to due to concern for choledocholithiasis. past medical history: cad (h/o angina, last cath which showed occluded marginal branch) h/o hemolytic anemia (treated w/prednisone 14 years ago) spinal stenosis s/p appendectomy diverticulitis colon polyps anxiety depression social history: h/o tobacco abuse x30-40 years, no additional details available on transfer family history: nc physical exam: physical exam (per dr. ) vs: 99.3 bp 127/82 rr 19 hr 93 100% on vc 50%/550/18/5 gen: intubated, sedated, restless in bed, opens eyes to voice, squeezes hands on command heent: nc at, pupils constricted, equal, minimally reactive to light cv: rrr, s1 s2 no appreciable murmur lungs: vented breath sounds, no significant crackles or wheezing abd: soft, non distended, no apparent tenderness, no guarding, bs hypoactive, percutaneous cholecystostomy drain in place ext: no significant pedal edema, palpable pulses bilaterally pertinent results: notable labs at osh: abg ph 7.14 pco2 62 po2 27 hco3 21 bun 33 creat 1.45 tbili 3.6 dbili 1.8 ast 1144 alt 913 aphos 216 60 lip 17 ua: 1+ leuk, nitr neg, 2+ urobili, 0 rbc, 1+ bacteria trop i <0.01 cpk 36 wbc 15.8 hct 27.3 plt 92 abg 7.33/41/86/21 (intubated) . blood cultures: klebsiella pneumonia resistant to ampicillin, otherwise sensitive to cefazolin, cefepime, ceftaz, ceftriaxone, ciprofloxacin, pip/tazo, imipenam, tmp/smx urine culture: pending on transfer . ekg: msr at 77 bpm, normal axis, qtc prolonged at 584 msec, otherwise normal intervals, no pathologic qwaves or st segment/t wave changes. compared with ekg from only significant change is new prolongation of qtc from 388 on . . ekg - nsr at 85bpm, normal axis, qtc 460 otherwise normal intervals bmp: 140 112 27 agap=10 -------------< 137 3.4 21 1.7 ck: 89 mb: 5 trop-t: 0.04 ck: 36 mb: 4 trop-t: 0.05 ca: 7.1 mg: 2.4 p: 3.8 alt: 329 ap: 123 tbili: 2.6 alb: 2.2 ast: 174 ldh: dbili: tprot: : 130 lip: 9 cbc: 10.4 17.0 >---< 105 31.0 n:94.2 band:0 l:2.7 m:2.5 e:0.5 bas:0.2 brief hospital course: mr. is a 78 yo m with pmh of cad admitted to osh with acute cholecystitis and septic shock, s/p percutaneous cholecystostomy tube placement. he was transferred to this hospital for ercp to evaluate possible choledocholithiasis. 1) acute cholecysitis: ercp was performed on to evaluate the extent of bilary tree involvement. ercp findings included: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: normal major papilla cannulation: cannulation of the biliary duct was successful and deep with a autotome 44 using a free-hand technique. contrast medium was injected resulting in complete opacification. the procedure was not difficult. a 0.035in in diameter and 260cm in length straight tip jagwire was placed. biliary tree: sludge that was causing partial obstruction was seen at the cbd. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. sludge was extracted successfully using a 9mm balloon. impression: sludge at the cbd (sphincterotomy, stone extraction) otherwise normal ercp to third part of the duodenum recommendations: follow for response/complications please call if develop jaundice, abdominal pain or black stools. continue iv antibiotics no aspirin. plavix, coumadin for 72 hours biliary drainage via perc chole tube was continued during admission. infectious disease was consulted at osh and decision was made to continue zosyn as primary antibiotic treatment. 2)sepsis: pt diagnosed with klebsiella bacteremia at osh, likely biliary source given cholecystitis and gnr on gram stain of gb fluid. chest x-ray, urine analysis and culture repeated on admission. infectious disease consulted at osh and zosyn continued. 3) hypoxic respiratory failure: he was intubated at osh for acute resiratory distress and hypoxia of unclear etiology at this time. abg prior to intubation with severe hypoxia and po2 of 27 with pco2 of 62. ddx includes acute lung injury/ards, flash pulmonary edema, pulmonary embolism, pneumonia, intracardiac/pulmonary shunt. chest x-ray on admission suggested pulmonary congestion and postoperative atelectasis. mechanical ventilation was continued. fentanyl and midazolam were used for sedation. pt appeared to be doing well following ercp. plan to wean pt off sedation and reassess possiblity of extubation. 3) acute renal failure: creatinine increased from 1.4 to 2.4 during his admission at osh, he was seen by renal consult service at osh who felt most likely to be due to atn in setting of sepsis. creatinine 1.7 at time of admission. medicines were renally dosed. iv fluids were administered to maintain a uop of 0.5-1.0 cc/kg/hr. . 4) nstemi/cad: at osh noted to have elevated troponin felt most likely to be demand ischemia rather than acs by cardiology consult service. patient was hemodynamically stable on admission and started on metoprolol 12.5 mg po bid. asa and plavix were held for 72 hours post-ercp. can be restarted . statin therapy was deferred for given transaminitis. cardiac enzymes were cycled x 2 with no indication of ischemia. . medications on admission: asa 81mg daily ativan 1-2mg iv q1h prn dilaudid 1-2mg iv q1h prn duoneb q4h heparin 5000sq tid lasix 40mg iv q8h prn levophed mag sulfate 50ml iv bid nexium 40mg iv daily zosyn 3.375g tpn tylenol 650mg q4hrs prn discharge medications: zosyn 2.25g iv q6h metoprolol 12.5mg po bid pantoprazole 40mg iv q24h heparin 5000units q8h albuterol mdi puff ih q4h prn ipratropium mdi 2 puff ih qid insulin sc sliding scale furosemide 40mg iv prn pulmonary edema discharge disposition: extended care facility: discharge diagnosis: primary: acute cholecystitis complicated by sepsis, hypoxic respiratory failure requiring mechanical ventilation, secondary: arf, cad discharge condition: stable discharge instructions: you were admitted to our hospital for evaluation of your gall bladder infection and to undergo an ercp procedure. you tolerated the procedure well and were discharged to . followup instructions: please notify gi if develop jaundice, abdominal pain or black stools. complete course of zosyn as instructed by id. follow up with gi to determine duration of perc chole drain. hold asa and plavix for 72hrs post-ercp. can restart . plan to start statin therapy when transaminitis resolves. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure, unspecified unspecified septicemia sepsis pulmonary collapse acute cholecystitis obstruction of bile duct 

Answer: The patient is high likely exposed to