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: nsaids (non-steroidal anti-inflammatory drug) attending: chief complaint: fever diarrhea septic shock major surgical or invasive procedure: none history of present illness: pt was recently diagnosed with a urinary tract infection on and started on ciprofloxacin. he was also was diagnosed with c. difficile at his rehab on and was on flagyl. of note, the patient was admitted from to for right testicular pain consistent with epididymitis thought to be related to repeated instrumentation of urethra and chronic indwelling catheterization. a ct scan of abdomen and pelvis was done due to concern for fournier's gangrene but was negative. his pain was managed with morphine and tylenol. he was started on vancomycin, flagyl, and levofloxacin. his urinalysis was "positive" and antibiotics were changed to ceftriaxone. he was discharged on a 14-day course of cefpodoxime that ended on . subsequently had a positive urine culture that was that was started with treatment with cipro. additionally, c. diff assay was positive , for which pt was started on flagyl. of note, a uti diagnosed on was resistent to levofloxacin and bactrim. there is also a note from his atrius urologist that in the past 2 months he had a 3 mm calculus with r side stent placement, with a planed ureteroscopy in the future. past medical history: - dmii - hypotonic hyposensitive bladder with urinary retention and chronic indwelling foley - afib not on coumadin - cerebral palsy - schf but could not find recent echo in system - htn - hl social history: patient is a limited historian. lives in facility. wheelchair bound. non-smoker. does not drink alcohol. family history: non-contributory physical exam: admission exam: vitals: 100.2 110 142/55 37 98% ra general: elderly male sitting comfortably in his chair. awake, alert, oriented, no acute distress. heent: tounge deviation to the left, mild slurring of speech, edentulous, dry mucus membranes with white inspissated mucus present, eomi, perrl neck: supple, jvp not elevated, rij in place cv: irregularly irregular, no murmurs, rubs, or gallops lungs: mild expiratory wheezes, minimal rhonchi c/w some secretions, no crackles abdomen: soft, non-tender, minimal distention, bowel sounds present gu: foley in place ext: warm, well perfused, 1+ pulses neuro: aaox3, patient diffusely weaker on the right versus left (chronic finding per patient report) . discharge exam: vs: t 97.8, tm 98.8, bp 130/70, hr 72, rr 16, o2 97% ra, bglu 190 i/o: /3900/no bm on record general: elderly male lying in bed. awake, alert, oriented, no acute distress. heent: tounge deviation to the left, mild slurring of speech, edentulous, inspissated mucus on uvula neck: supple, rij in place, no lad, no jvd cv: irregularly irregular, no murmurs, rubs, or gallops lungs: no respiratory distress, ctab abdomen: soft, non-tender, minimal distention, bowel sounds present, no cva tenderness gu: foley in place ext: warm, well perfused, 1+ pulses, no edema b/l, scds in place bilaterally neuro: aaox3, patient diffusely weaker on the right versus left (chronic finding per patient report) pertinent results: 03:30am blood wbc-19.4*# rbc-3.51* hgb-10.4* hct-30.5* mcv-87 mch-29.5 mchc-34.0 rdw-14.8 plt ct-231 01:15pm blood wbc-17.6* rbc-3.22* hgb-9.8* hct-28.4* mcv-88 mch-30.4 mchc-34.4 rdw-15.0 plt ct-222 03:30am blood neuts-89.2* lymphs-4.6* monos-5.6 eos-0.5 baso-0.2 01:15pm blood neuts-89.6* lymphs-5.4* monos-4.6 eos-0.1 baso-0.2 03:30am blood plt ct-231 01:15pm blood pt-14.1* ptt-30.3 inr(pt)-1.3* 03:30am blood glucose-281* urean-20 creat-1.0 na-129* k-4.1 cl-96 hco3-21* angap-16 01:15pm blood glucose-250* urean-16 creat-0.8 na-134 k-3.8 cl-104 hco3-20* angap-14 03:30am blood alt-13 ast-16 ck(cpk)-32* alkphos-72 totbili-0.3 03:30am blood ck-mb-1 ctropnt-0.04* 03:30am blood albumin-3.7 01:15pm blood calcium-7.7* phos-1.9* mg-1.1* 03:30am blood digoxin-0.7* 03:42am blood lactate-3.8* 05:50am blood lactate-3.2* 01:29pm blood lactate-1.8 01:29pm blood o2 sat-65 . relevant labs: 03:25am blood wbc-9.2 rbc-2.76* hgb-8.3* hct-24.3* mcv-88 mch-30.2 mchc-34.3 rdw-15.0 plt ct-181 03:25am blood glucose-181* urean-12 creat-0.8 na-134 k-3.3 cl-106 hco3-21* angap-10 03:25am blood ck(cpk)-44* 03:25am blood ck-mb-3 ctropnt-0.07* 03:25am blood calcium-7.3* phos-2.5* mg-2.0 06:46am blood vanco-10.4 03:37am blood type- temp-37.9 po2-124* pco2-40 ph-7.33* caltco2-22 base xs--4 comment-green top 08:50am blood caltibc-229* ferritn-799* trf-176* 06:15am blood wbc-6.5 rbc-3.00* hgb-9.1* hct-26.0* mcv-87 mch-30.5 mchc-35.2* rdw-15.1 plt ct-273 05:50am blood glucose-202* urean-9 creat-0.9 na-138 k-3.8 cl-106 hco3-26 angap-10 08:50am blood ck-mb-2 ctropnt-0.05* 05:50am blood calcium-7.9* phos-2.2* mg-1.8 06:15am blood digoxin-0.2* . discharge labs: 05:49am blood wbc-9.7 rbc-3.28* hgb-10.1* hct-29.0* mcv-88 mch-30.7 mchc-34.8 rdw-15.9* plt ct-362 05:49am blood glucose-165* urean-12 creat-0.9 na-139 k-4.1 cl-102 hco3-29 angap-12 05:49am blood calcium-9.0 phos-3.8 mg-1.7 . imaging: @ 0329 - cxr - impression: mild pulmonary edema though no consolidation. @ 0630 - cxr - impression: 1. new central venous catheter terminating in the mid svc. 2. stable mild interstitial pulmonary edema. @ 1309 - abd xr - impression: bowel gas pattern consistent with ileus. no evidence of obstruction or toxic megacolon. @ 1659 - abd ct w/ & w/o contrast - impression: 1. mild colitis involving the cecum. 2. renal stent in proper position. 3. there is no evidence of pyelonephritis. 4. new bilateral pleural effusions. 5 unchanged 1.3 cm left adrenal lesion that is indeterminate by ct size criteria, however, it most likely represents a lipid poor adenoma. 6. foley catheter balloon in the prostate. 7. non-obstructing 2mm right renal calculus. - echo - impression: the left atrium is elongated. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. - cxr - reason for exam: assess right picc after power flush. comparison is made with prior study performed one hour earlier. left picc tip is difficult to visualized, can be followed to the cavoatrial junction. there is no pneumothorax or pleural effusion. there are no other interval changes. . micro: 3:30 am blood culture **final report ** blood culture, routine (final ): klebsiella pneumoniae. identification and sensitivities performed on culture # 353 5861c . aerobic bottle gram stain (final ): gram negative rod(s). 3:30 am urine site: catheter **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed skin/genital flora. clinical significance of isolate(s) uncertain. interpret with caution. klebsiella pneumoniae. >100,000 organisms/ml.. sensitivity testing performed by microscan. meropenem <=1 mcg/ml. cefepime >16 mcg/ml. sulfa x trimeth >2 mcg/ml. klebsiella pneumoniae. >100,000 organisms/ml.. sensitivity testing performed by microscan. meropenem <=1 mcg/ml. cefepime >16 mcg/ml. sulfa x trimeth >2 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | klebsiella pneumoniae | | ampicillin/sulbactam-- =>32 r 16 i cefazolin------------- =>32 r =>32 r cefepime-------------- r r ceftazidime----------- 4 s 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem------------- s s nitrofurantoin-------- <=32 s 32 s tobramycin------------ =>16 r 8 i trimethoprim/sulfa---- r r 3:45 am blood culture # 2. **final report ** blood culture, routine (final ): klebsiella pneumoniae. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- 4 s ceftriaxone----------- 16 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r anaerobic bottle gram stain (final ): reported to and read back by @ 1725 on - . gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). 6:30 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. 2:30 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 12:29 pm urine source: catheter. **final report ** urine culture (final ): yeast. >100,000 organisms/ml.. brief hospital course: mr. is an 81m with dmii, chronic indwelling foley due to urinary retention, cerebral palsy, atrial fibrillation not anti-coagulated presents with septic shock . # septic shock: the patient was aggressively fluid resucitated in the ed and icu per rivers protocol; he was briefly on norepinephrine in the ed, but had weaned by the time he arrived to the icu. u/a findings (reported "pus" in the foley initially) as well as recent instrumention and stenting in the past 2 months, with what appears per records to be several rounds of utis pointed to an etiology of urosepsis. of note, ct abd revealed right ureteral stent, nonspecific perinephric stranding unchanged from . as such, the patient initially in the icu was covered with vancomycin iv, cefepime iv, vancomycin po, and iv metronidazole to cover potential lung, urine, and colonic srouces, with a plan to wean antibiotics on the floor. he was subsequently found to have klebsiella pneumonia in the blood, and was narrowed to cefepime iv, vancomycin po, and iv metronidazole. urine cx from osh grew klebsiella pneumonia esbl+ sensitive to cefepime, but urine culture from here grew two different strains of k. pneumonia resistant to cefepime. due to resistance panel, a picc line was placed and a 10d course of iv meropenem 500mg q6 was started, beginning on and expected to go on until the evening of the 14th. we did not consult urology since pt has an outpt appt and is doing ok clinically. . # c. difficile diarrhea: patient has fever, wbc > 15. also > age 65 years old. he has evidence of sepsis and elevated serum lactate (> 2.5), which may be from sepsis from a urinary source. he does thus meet criteria severe c. difficile criteria per guidelines. as such, he was started on vancomycin 500 mg po q 6 hr, and reduced to 125 mg po q 6 hr, then to po metronidazole. due to other infections, will continue flagyl for 1w post other abx. he will continue metronidazole 500mg tid until 1 week after the meropenem has been d/c'ed' # bradycardia: patient was bradycardic to 40s, asymptomatic, on metoprolol succinate. this was discontinued and the digoxin will be used for rate control. the rates were in the 60s-70s on discharge. . # hyponatremia: likely hypovolemic in the setting of diarrheal loses, patient endorses thirst and has dry mm. resolved after fluid resucitation. . # mild metabolic acidosis: likely secondary to fluid resustication with ns and and diarrheal losses. resolved. . # atrial fibrillation: patient is chads2 of > 2, has not elected to be on coumadin. we continued asa in house. off metorpolol due to bradycardia. on digoxin for rate control. . # normocytic, normochromic anemia: unclear etiology, stable from prior admission . # dm2: blood sugars consistently were in the 300's at the beginning of the admission, so a standing bedtime dose of lantus was added to his sliding scale. also, his sliding scale was adjusted accordingly throughout the hospital course. . # congestive heart failure: there is no echo on file at or atrius but per reports, patient has history of ? heart failure. an echo was ordred prior to his discharge from the icu, results above. ekg done on showed asymmetric t-wave inversions in v1, meaning possible left heart strain. given his cardiac history, findings of edema and lung sounds, and the fluid recussitation, the most likely reason for the strain was the ns bolus during septic shock. the pt was given iv lasix with resolution of his edema and lung findings. . # transitional issues - 10d course of iv meropenem 500mg q6. day 1 = . day 10 = stop in evening - po metronidazole 500mg tid. d/c 1 week after meropenem is stopped = - picc line in place, will be removed when completes the course of antibiotics pending studies: none medications on admission: preadmission medications listed are correct and complete. information was obtained from . 1. ciprofloxacin hcl 250 mg po q12h planned for for 5 days, started end 2. senna 2 tab po bid:prn constipation 3. trazodone 25 mg po hs:prn insomnia 4. biscolax *nf* (bisacodyl) 10 mg rectal daily:prn constipation 5. milk of magnesia 30 ml po daily:prn constipation 6. acetaminophen 500 mg po q6h:prn fever,pain 7. aspirin 325 mg po daily 8. calcium carbonate 500 mg po bid 9. digoxin 0.25 mg po every other day 10. furosemide 20 mg po daily 11. metformin (glucophage) 1000 mg po bid 12. metoprolol succinate xl 25 mg po daily hold for sbp< 100, hr <60 13. multivitamins 1 tab po daily 14. omeprazole 20 mg po daily 15. simvastatin 10 mg po qhs 16. timolol maleate 0.5% 1 drop both eyes 17. vitamin d 400 unit po bid 18. loratadine *nf* 10 mg oral daily 19. finasteride 5 mg po daily 20. tamsulosin 0.4 mg po hs 21. metronidazole (flagyl) 500 mg po tid daily 22. glipizide 10 mg po bid 23. lisinopril 5 mg po daily discharge medications: 1. acetaminophen 500 mg po q6h:prn fever,pain 2. aspirin 325 mg po daily 3. calcium carbonate 500 mg po bid 4. digoxin 0.25 mg po every other day on even days, start 5. furosemide 20 mg po daily 6. lisinopril 5 mg po daily 7. metronidazole (flagyl) 500 mg po q8h continue until 1 week after meropenem has been discontinued, rx *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours disp #*45 tablet refills:*0 8. multivitamins 1 tab po daily 9. omeprazole 20 mg po daily 10. senna 2 tab po bid:prn constipation 11. simvastatin 10 mg po qhs 12. timolol maleate 0.5% 1 drop both eyes 13. vitamin d 400 unit po bid 14. meropenem 500 mg iv q6h duration: 8 days last dose 6pm rx *meropenem 500 mg every six (6) hours disp #*30 vial refills:*0 15. biscolax *nf* (bisacodyl) 10 mg rectal daily:prn constipation 16. finasteride 5 mg po daily 17. glipizide 10 mg po bid 18. loratadine *nf* 10 mg oral daily 19. metformin (glucophage) 1000 mg po bid 20. milk of magnesia 30 ml po daily:prn constipation 21. tamsulosin 0.4 mg po hs 22. trazodone 25 mg po hs:prn insomnia discharge disposition: extended care facility: house discharge diagnosis: primary dx: urosepsis secondary dx: c. diff, atrial fibrillation, urinary tract infection, type 2 diabetes, congestive heart failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you during your hospitalization at . you were admitted for urosepsis. the fevers you were experiencing were secondary to bacteria from your urinary tract infection invading your bloodstream. you also had a c.diff infection in your gastrointestinal system. this lead to your diarrheal episodes. you were treated with antibiotics for both the urosepsis and c.diff infections. please continue to monitor your symptoms, and notify your primary care physician if they worsen. the following changes were made to your medications: -take meropenem 500mg every 6 hrs through -take flagyl 500mg every 8 hours through -stop metoprolol succinate good luck in your recovery. followup instructions: please follow up with your urologist at the previously made appointment. department: pat preadmission testing when: tuesday at 10:15 am with: pat-preadmission testing building: cc campus: west best parking: garage procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: acidosis anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia severe sepsis atrial fibrillation acute on chronic diastolic heart failure other specified cardiac dysrhythmias septic shock intestinal infection due to clostridium difficile other septicemia due to gram-negative organisms do not resuscitate status infantile cerebral palsy, unspecified other specified retention of urine wheelchair dependence hypertonicity of bladder 

Answer: The patient is high likely exposed to