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 allergies/adrs on file attending: chief complaint: hypotension on pressors major surgical or invasive procedure: right internal jugular central line placement history of present illness: f with a history of hypertension, cad s/p mi, atrial fibrillation who presented from facility ( in ) with a one day history of fever to 102 and lethargy following several days of feeling unwell with poor po intake. according to her daughter, she was very well earlier in the week (they went out to lunch on wednesday and she seemed fine at that time). of note, she had a recent uti which was treated with a course of antibiotics, though family is unaware of the name of the medication. she left a blood sample when she saw her doctor at that visit a few weeks back, but unfortunately was unable to produce a urine sample at that time so it sounds as though no culture was obtained. she was taken to hospital in initially, but transferred to given no icu beds there. at , initial vitals were bp 65/49, hr 154, rr 22, t 99.1, 99% on ra. she was noted to be in ? svt on arrival with rate to 140s-150s. she has known history of a-fib. this self-resolved -> sinus rhythm following 3l ivf. she remained hypotensive to 77/46 despite ivf, so cvl (right ij) was placed in sterile fashion and she was started on levophed. u/a was positive for infection; cxr was clear. ceftazidime 1g iv and vancomycin 1g iv administered. in the ed, initial vs were: t 97.6, hr 80, bp 128/90, rr 20, o2 sat 96% on ra. set of labs were drawn (including repeat u/a and ucx) and cvl placement was confirmed by cxr. labs notable for lactate is 1.0. she was noted to be alert and oriented x 3 in the ed though with very limited memory of the day's events. bps were stable on levophed. pt in nsr with controlled rate. got one dose of pr acetaminophen. vitals on transfer hr 83, bp 133/76 (on levophed 0.09), rr 20, 100% ra. just prior to transfer, patient was noted to develop svt (not a-fib) with rate to 160. she was given 3 mg of adenosine and converted back to nsr with rate in 80s. . on arrival to the micu, she is somnolent but rousable. she answers many qs appropriately, but ignores other qs. not oriented to hospital/icu at this time. inattentive/sleepy. . review of systems: reports some pain in her back which is chronic; she is unable to qualify this on numerical pain scale. denies cp or sob. deneis abdominal pain. remainder of ros could not be accurately obtained due to somnolence. past medical history: - atrial fibrillation on amiodarone, atenolol - hypertension - cad s/p mi per osh records (per family, no prior mi) - frequent uti (completed course of abx ~ 10 days ago) - has some ? bladder prolapse and has suffered from recent incontinence (on oxybutinin) - primary biliary cirrhosis on ursodiol (followed by a gastroenterologist) - anxiety (family reports mirtazepine is for this indication) - chronic back pain - s/p cholecystectomy - chronic gerd and atypical chest pain social history: has 4 children. lives alone in ( in ) and is independent with most adls (does have assistance with bathing for safety reasons). uses a walker at baseline. - tobacco: none - alcohol: none - illicits: none family history: n/c physical exam: admission: general: resting in bed, rousable but confused. unable to name hospital. knows date as . drifting off mid-conversation. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad, rij in place cv: regular rate and rhythm, slightly hyperdynamic s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly (patient winces slightly during exam, but denies pain with palpation when asked) gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no gross focal defects noted; full exam deferred due to patient somnolence discharge physical exam: physical exam: vitals: 98.4 118/82 74 16 98%2l general: comfortable, alert and oriented x3, appropriate. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated cv: regular rate and rhythm, -m/r/g lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no gross focal defects noted pertinent results: labs on admission to : labs from in : - wbc 14.4 (91n/3l/6m/0e/0b), hgb 10.8, hct 31.4, plt 255 - troponin t < 0.03, cpk 165, ck-mb 2.9 (mb% 1.8) - inr 1.2, ptt 31.0 - u/a with cloudy appearance, moderate blood and leukocytes, 100 protein - lactate 1.8 micro: ( ): - blood culture : e. coli (pan-sensitive, see below) (): - blood culture : e.coli 2/2 bottles (pan-sensitive, see below) - blood culture : e.coli 2/2 bottles (pan-sensitive, see below) - urine culture : e.coli (pan-sensitive, see below) escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s imaging: cxr : impression: right-sided internal jugular venous catheter with tip in the mid svc. no pnuemothorax. cxr : findings: as compared to the previous radiograph, the right central venous access line has been removed. the right picc line is in unchanged position. unchanged bilateral pleural effusions with moderate fluid overload. unchanged mild cardiomegaly and bilateral areas of atelectasis. no evidence of pneumonia. renal u/s : impression: 1. 2-cm complex left mid pole cystic lesion might represent an abscess. 2. small amount of right hydronephrosis. 03:06am blood wbc-16.0* rbc-3.10* hgb-10.4* hct-30.0* mcv-97 mch-33.7* mchc-34.8 rdw-13.2 plt ct-226 03:28am blood wbc-15.6* rbc-2.84* hgb-9.6* hct-28.3* mcv-100* mch-33.8* mchc-34.0 rdw-13.4 plt ct-235 12:55pm blood wbc-16.5* rbc-2.98* hgb-9.9* hct-29.2* mcv-98 mch-33.3* mchc-34.0 rdw-13.7 plt ct-201 03:14am blood wbc-15.2* rbc-2.77* hgb-9.2* hct-27.1* mcv-98 mch-33.2* mchc-33.9 rdw-13.8 plt ct-200 03:37am blood wbc-14.0* rbc-2.80* hgb-9.3* hct-27.8* mcv-100* mch-33.2* mchc-33.3 rdw-13.9 plt ct-231 06:13am blood wbc-12.4* rbc-2.81* hgb-9.4* hct-28.1* mcv-100* mch-33.4* mchc-33.4 rdw-14.2 plt ct-276 06:45am blood wbc-13.6* rbc-2.94* hgb-9.7* hct-28.6* mcv-97 mch-32.9* mchc-33.9 rdw-13.7 plt ct-302 06:45am blood neuts-80.9* lymphs-11.1* monos-2.7 eos-3.3 baso-2.1* 03:06am blood pt-13.7* ptt-32.1 inr(pt)-1.3* 03:14am blood pt-13.0* ptt-39.1* inr(pt)-1.2* 03:37am blood pt-12.5 ptt-37.3* inr(pt)-1.2* 03:06am blood glucose-121* urean-43* creat-2.1* na-129* k-4.2 cl-97 hco3-20* angap-16 10:36am blood glucose-138* urean-40* creat-1.8* na-132* k-4.0 cl-103 hco3-17* angap-16 03:28am blood glucose-131* urean-38* creat-1.4* na-132* k-3.4 cl-105 hco3-19* angap-11 12:55pm blood glucose-133* urean-37* creat-1.4* na-134 k-3.4 cl-106 hco3-19* angap-12 03:14am blood glucose-106* urean-36* creat-1.3* na-137 k-4.4 cl-110* hco3-20* angap-11 03:37am blood glucose-100 urean-33* creat-1.2* na-136 k-3.6 cl-109* hco3-17* angap-14 06:13am blood glucose-102* urean-26* creat-1.0 na-139 k-3.5 cl-109* hco3-20* angap-14 06:45am blood glucose-97 urean-18 creat-0.8 na-140 k-2.7* cl-104 hco3-24 angap-15 01:10pm blood glucose-130* urean-20 creat-0.9 na-140 k-3.9 cl-108 hco3-24 angap-12 03:37am blood albumin-2.4* calcium-8.1* phos-2.4* mg-1.9 06:03am blood vanco-4.0* 03:28am blood cortsol-25.7* 03:06am blood lactate-1.0 11:04am blood lactate-1.4 01:08pm blood lactate-1.3 brief hospital course: hospital summary: f with history of atrial fibrillation and frequent uti who presented to osh with fever and lethargy found to have septic shock from uti. osh course complicated by svt to 140s-150s (self-resolved after ivf) and hypotension requiring pressors. overall clinical picture consistent with urosepsis; she was placed on norepinephrine for pressure support and admitted to the medical icu. she was treated with antibiotics for her urosepsis and episodes of svt were managed with hydration, amiodarone and adenosine. vitals stabilized and she was called out to the medical floor on hospital day #4. on the floor, she had sporadic episodes of both avnrt to rates of 160 that spontaneously resolved and atrial fibrillation with rates of approximately 110 with sporadic bursts to 140. all svt was hemodynamically stable and asymptomatic. active issues: # septic shock with uti: patient initially met sirs criteria with tachycardia, leukocytosis, tachypnea secondary to infection. source was urine, given history of frequent uti, +u/a at osh, and relatively clear cxr and absence of other localizing symptoms. bps were refractory to ivf so she was initiated on norepinephrine; cvl (rij) was placed at osh. she was treated with vancomycin and zosyn initially for broad-spectrum coverage; this regimen was narrowed to ceftriaxone when cultures ultimately revealed pan-sensitive e. coli in the blood and urine. she will require 2 weeks of iv ceftriaxone for bacteremia from the first negative culture on . she will also require outpatient follow-up with urology for bladder prolapse, which over the past year has caused multiple utis. # tachyarrhythmia: the patient with a known history of atrial fibrillation not on coumadin was noted to be in a supraventricular tachyarrhythmia first at osh with rate to 140s-150s. this self-resolved after administration of ivf, but recurred in the ed with rate to 160s; this broke with 3 mg adenosine. this svt was felt to be avnrt by electrophysiology, which she was not known to have. she had several further episodes during her icu stay with rates to 150-160, initially associated with hypotension/increasing pressor requirement. these were managed initially with a one-time dose of 150 mg iv amiodarone (then pt was resumed on her home dose of 100 mg po daily) and 3 mg adenosine prn. once blood pressures stabilized, she was started on low-dose metoprolol. on had persistent avnrt (hemodynamically stable) and received adenosine 3mg x2, followed by another 150 mg iv amiodarone which eventually broke her. cardiology was consulted and recommended increasing her amiodarone to 200 mg daily for seven days and continuing her metoprolol at 12.5 mg . cards felt that this arrhythmia was likely secondary to increased catecholamine from septic shock, and would resolve eventually. on the floor, she had few sporadic and self-limiting second bursts of avnrt to 160s, which were asymptomatic and hemodynamically stable. she also had a few episodes of atrial fibrillation at rates of approximately 110 with bursts to 140s, again hemodynamically stable and asymptomatic. her beta blocker was uptitrated at this point to tid to ensure good rate control when in atrial fibrillation. she is being discharged on 12.5 tid, with plan to convert stable long acting metoprolol when discharged. she is also being discharged on amiodarone 100mg with plan to go back to 100mg qd after 7 days. she should be discharged on amio 100 qd and toprol xl 25-37.5mg with cardiology follow-up. per cardiology, she tolerates these episodes well and watchful waiting is a good strategy as long as she is hemodynamically stable and without significant symptoms. # diarrhea: started a few days after antibiotics. guaiac negative, cdiff toxin negative. she had a leukocytosis that was elevated but stable throughout her hospital course. it was felt that her diarrhea was likely antibiotic associated diarrhea rather than cdiff infection. a cdiff pcr was sent which is pending at time of discharge; if this returns positive, we will contact the rehabilitation facility for plan of day course of po flagyl. at the time of discharge, however, our suspicion for cdiff is low and she is not on flagyl. her volume status should be monitored closely, and po fluids strongly encouraged to avoid . # acute renal failure: creatinine was 2.1 on arrival to ; prior baseline was 0.8 per pcp . medications were renally dosed and nephrotoxins avoided (ibuprofen was held). urine lytes were consistent with a prerenal/atn picture likely secondary to sepsis. creatinine trended down to 0.8 at the time of discharge. urine output was excellent throughout. # hyponatremia: na 129 on arrival. patient appeared euvolemic after 3l ivf, though felt she was still dehydrated. hyponatremia was likely hypovolemic; this resolved with ivf. inactive issues: # anemia: hct ~30. baseline unknown. normocytic with mcv 94. no evidence of active bleeding. hct remained stable in-house. # coronary artery disease: has history of mi in records, but per family no known mi. continued aspirin, started metoprolol. # hypertension: discontinued home amlodipine due to hypotension initially, then diarrhea at the time of discharge and concern for future hypovolemia. as lopressor was added for rate control, her amlodipine was discontinued at discharge until pcp . # chronic back pain: mild at this time. oxycodone was continued. ibuprofen was discontinued due to renal failure, and was discontinued upon discharge. # incontinence, frequent uti: oxybutinin was continued. she will need outpatient evaluation by urology for suspected bladder prolapse leading to multiple utis. # primary biliary cirrhosis: details unknown. followed by outpatient gastroenterologist. she was noted to have mildly elevated alk phos c/w baseline but otherwise normal lfts. continued ursodiol. # prophylaxis: subcutaneous heparin, home ppi transitional issues: - code status during this admission dnr/dni - contacts: son ( or ), daughter (hcp; ). other contacts are pcp in (), facility in , and in . - will need further urologic evaluation as an outpatient medications on admission: (reconcilled with pharmacy) oxycodone 5mg tid prn mirtazipine 7.5mg qhs amiodarone 100mg daily amlodipine 2.5mg daily lidoderm patch ursodiol 300mg tid tramadol 25mg q8h prn ibuprofen 400mg q6h prn oxybutynin 5mg daily omeprazole - stopped aspirin 81mg daily multivitamin daily calcium and vitamin d colace 100mg discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever/pain. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. oxycodone 5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 5. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 6. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 8. amiodarone 200 mg tablet sig: one (1) tablet po once a day for 7 days: last day . 9. amiodarone 100 mg tablet sig: one (1) tablet po once a day: start and continue indefinitely. 10. oxybutynin chloride 5 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po every eight (8) hours. 12. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours): last day . 13. multivitamin tablet sig: one (1) tablet po once a day. 14. calcium 500 + d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: healthcare center - discharge diagnosis: septic shock uti atrial fibrillation with rapid ventricular rate av nodal reentry tachycardia antibiotic associated diarrhea acute kidney injury discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you were transferred to our icu for septic shock from a urinary tract infection. you were given iv antibiotics and iv fluids as well as medications to increase your blood pressure and you improved. you have an irregular heart rhythm. while you do have a history of atrial fibrillation, you also had a different rhythm called av nodal reentrant tachycardia. this other rhythm, while occurring a few times per day, was brief at each episode. we increased your metoprolol and your amiodarone to help control your heart rate. you developed diarrhea, likely from the antibiotics used to treat your urinary tract infection. the diarrhea should improve once the antibiotics are finished. we made a few changes to your medications: -increase amiodarone 100mg by mouth to twice per day (increased from once) for one week (last day ), then go back to home dose: 100mg daily -start metoprolol tartrate 12.5mg by mouth three times per day. this medication can be switched to a long acting version by your rehab when you are ready for discharge. - start ceftriaxone 1g iv every 24 hours, last day - stop tramadol - stop amlodipine 2.5mg by mouth until you see your primary care doctor (this was stopped because you were started on metoprolol which will help control your blood pressure). - start tylenol as needed for pain - stop ibuprofen - stop colace until your diarrhea resolves followup instructions: with your primary care doctor 1 week after discharge with your cardiologist 2-4 weeks after discharge procedure: percutaneous abdominal drainage central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis atrial fibrillation anxiety state, unspecified other specified cardiac dysrhythmias septic shock old myocardial infarction hypoxemia diarrhea do not resuscitate status lumbago septicemia due to escherichia coli [e. coli] urinary incontinence, unspecified leukocytosis, unspecified biliary cirrhosis other acute and subacute forms of ischemic heart disease, other personal history, urinary (tract) infection other fluid overload cystocele, midline unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to