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: codeine / zofran attending: chief complaint: transfer from osh for acute renal failure, nephrolithiasis major surgical or invasive procedure: intubation placement of left nephrostomy tube cystoscopy history of present illness: 70 y/o m with a pmhx of nephrolithiasis, copd, uc, htn who was admitted to hosp on for 3d of worsening l flank pain. no f/chills. able to take pos. an u/s showed 11mm calculus in mid-portion of l kidney and 8mm in lower pole. nml r kidney. evid of mild-mod hydronephrosis; creat elevated to 2.0. made npo, placed on pca which was weaned to percocet po prn. foley placed with initial hematuria now clearing. . today, c/o dull discomfort in abd, not severe. +constipation without bms x4d c/b bloating. tol pos. no cp, sob, cough. shortly after admission, transferred to the icu with the following admit note: 70m pmh nephrolithiasis, copd (fev1 of 1.17 on continuous 2-2.5l o2 at home, uc, crf (baseline creatinine 1.5) who was admitted to hosp on for three-day history of worsening l flank pain and hematuria. he was found to have an 11mm calculus in mid-portion of l kidney and 8mm in lower pole with mild-mod hydronephrosis. creatinine as 2.4. the patient was transferred to and has been followed by urology during admission. the patient was not believed to be a candidate for a surgical procedure given the requirement of general anesthesia and intubation. us-guided percutaneous nephrostomy placement was attempted but was unsuccessful. per report, during the procedure the patient's blood pressure dropped to the 80s after initiation of propofol and was slow to improve despite 700cc ns bolus (not well documented). radiology has suggested a ct-guided procedure as the next step. . since admission, the patient has triggered three times. the first was for af with rvr responding to lopressor and diltiazem with conversion to nsr. the second and third were for anxiety, hypoxia, and svt, again responding to lopressor and diltiazem. . on transfer, the patient complains of left-sided flank pain. he states his breathing is at baseline. he complains of constipation. he denies fever, chills, chest pain, abdominal pain, nausea, vomiting. past medical history: 1) copd on 2l home o2 (fev1 1.17l (35% pred) in ), steroid-dependent 2) htn 3) uc 4) bph 5) nephrolithiasis 6) stage iii ckd cr 1.5 thought due to recurrent nephrolithiasis social history: tob: 100pk yr hx; quit 8 yrs ago. etoh: none. no ivdu. currently retired. family history: b kidney stones physical exam: t: 96.2, bp 124/74, hr 87, rr 20 sat 96% on 3l gen: elderly male in nad, comfortable at rest heent: anicteric, perrl/eomi, op clear without lesions, mm dry. neck: supple, no lad cv: rrr, nml s1,s2, no m/r/g resp: distant breath sounds. decreased air movement throughout. prolonged expiration, sparse wheezes abd: soft, nontender back: left nephrostomy tube with clear yellow urine drainage ext: 2+ edema bilateral le to knee neuro: aaox2. moves all extremities spontaneously. pertinent results: 01:15am blood wbc-10.2 rbc-3.91* hgb-12.2* hct-37.4* mcv-96 mch-31.1 mchc-32.6 rdw-13.4 plt ct-223 04:58pm blood wbc-38.6* rbc-3.66* hgb-11.4* hct-35.6* mcv-97 mch-31.3 mchc-32.2 rdw-14.4 plt ct-184 04:08am blood wbc-11.5* rbc-3.20* hgb-9.8* hct-30.6* mcv-96 mch-30.5 mchc-31.9 rdw-14.0 plt ct-534* 01:15am blood glucose-120* urean-17 creat-2.3* na-138 k-4.0 cl-106 hco3-20* angap-16 04:08am blood glucose-131* urean-49* creat-1.1 na-143 k-4.3 cl-100 hco3-37* angap-10 05:05am blood ck(cpk)-1366* 03:30pm blood ck-mb-8 ctropnt-0.05* 10:10pm blood ck-mb-12* mb indx-1.3 ctropnt-0.08* 05:05am blood ck-mb-15* mb indx-1.1 ctropnt-0.09* 04:59am blood digoxin-0.9 05:07pm blood type-art temp-36.7 rates-25/0 tidal v-450 peep-5 fio2-40 po2-95 pco2-50* ph-7.24* caltco2-22 base xs--6 -assist/con intubat-intubated 02:53pm blood type-art po2-84* pco2-50* ph-7.46* caltco2-37* base xs-9 08:05pm urine blood-lge nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 09:51pm urine rbc-457* wbc-99* bacteri-rare yeast-none epi-0 . 8:05 pm urine source: catheter. urine culture (final ): escherichia coli. >100,000 organisms/ml.. | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . blood culture aerobic bottle (final ): escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s . cdiff negative x 3. . imaging: renal u.s. 12:56 pm impression: moderate-sized left inter-to-lower pole collecting system calculi with mild left-sided hydronephrosis. no distal ureteral/bladder calculi could be identified, however, exam is limited due to bladder decompression from decompressed foley. if outside imaging is available, comparison would be helpful. . ct abdomen/pelvis w/o contrast 8:46 am impression: 1. left proximal ureter obstructing stone with moderate hydronephrosis and proximal ureter dilation. 2. severe emphysema. 3. bladder stone . ct abdomen/pelvis w/o contrast 4:55 pm impression: 1. 1-cm left renal stone with 5-mm obstructing left ureteral stone with mild hydronephrosis; perinephric fat stranding likely due to recent intervention. no perinephric fluid collection or bowel perforation. 2. persistent mildly dilated large bowel proximally with gas and liquid stool. air bubbles along the dependent cecal and ascending colon wall are most likely luminal but the possibility of a component of pneumatosis cannot be completely excluded in this patient with mechanical ventilation and sepsis. 3. large urinary bladder stone. 4. bilateral pleural effusion with atelectasis and severe bullous and centrilobular emphysema. increased opacity in the left lower lobe could be superimposed pneumonia. . ct abdomen/pelvis w/o contrast 2:10 pm impression: 1. no evidence of pneumatosis. 2. limited study due to lack of intravenous contrast . interval placement of percutaneous nephrostomy catheter, with a left renal stone and two left ureteral stones. large bladder stone. diffuse anasarca. diverticulosis. 3. bilateral effusion and atelectasis with consolidation in the right lung base, unchanged. echo conclusions the left atrium is normal in size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is an anterior space which most likely represents a fat pad. impression: hyperdynamic left ventricle with mild resting outflow gradient. due to poor echo windows, a wall motion abnormality cannot be ruled out. brief hospital course: a/p: 70m pmh nephrolithiasis, copd (fev1 of 1.17 on continuous 2-2.5l o2 at home, uc, htn presenting with obstructing ureteral stone, acute on transferred to icu for peri-procedure hypotension. . # urosepsis: admitted with urosepsis in the setting of obstructing nephrolithiasis. ecoli subsequently grew out of urine and blood cutlures. nephrostomy tube was placed on after failure to place on . he was originally on pressors, then weaned successfully from the pressors and remained hemodynamically stable. total 14 day course of ceftriaxone will be completed (counting starting date when nephrostomy placed, although he received cipro/cefipime for four days prior). . # respiratory failure/copd exacerbation (acute on chronic bronchitis): he has significant underlying lung disease with copd on 2l home o2 (fev1 1.17l (35% pred). he was intubated respiratory failure and remained ventilated for roughly 6 days. respiratory distress likely represented a copd exacerbation in the setting of uti and urosepsis. there was no evidence at that time of uri as he was without cxr infiltrate and sputum production. several days of vent weening was complicated by sedation, hypoxia, hypercarbia, and acidosis. one episode of hypoxia on thought to be from autopeeping, improved with increased peep. extubated on and was initially agitated with good oxygen saturation. his lungs had wheezing for the next couple days, but this responded to bronchodilators and steroids. he was maintained on iv methylprednisolone and bronchodilators. he remained mildly short of breath though with good o2 sats throughout the rest of his micu stay, and subsequently returned to baseline on the floor. he was discharged on spiriva, advair, albuterol nebs, and a prednisone taper (over 3 weeks). . # delerium: likely component of multiple meds, acute illness and icu stay resulting in delirium. haldol, zyprexa, and mophine was given as above and his agitation and ams improved by the 3rd or 4th day after extubation. his family reports he is close to baseline, although he still has daily variability in mental status (worse in early am, near baseline in pm). . # pneumatosis intestinalis: abd ct on showed pneumatosis intestinalis. he was deemed to be a poor surgical candidate. he was maintained on supportive treatment with bowel rest. on repeat ct, the pneumatosis had resolved. his bowel status improved through the rest of his ic stay and he was taking small amounts of po before being transferred to the floor. . # leukocytosis: he had persistently high wbc and low grade fever. it was likely multifactorial from steroids and urosepsis. he was maintained on oral vancomycin and iv flagyl while not taking po given concern for possible c. diff, however he was toxing negative x3. wbc normal on discharge . # hypertension: he became more consistently hypertensive and tachycardic toward the end of his stay. he was started on po dilt which was titrated for more ideal bp and hr. . # hypernatremia: mild, likely secondary to relatively free water output from kidney - post-obstructive diuresis. free water deficit 4l on . . # hydronephrosis/nephrolithiasis: left proximal ureter obstructing stone with moderate hydronephrosis and proximal ureter dilation noted on ct as above. bladder stone also noted. treatment for urosepsis as above. cystoscopy showed large papillary bladder tumor obstructing trigone. left nephrostomy tube placed by ir on . he has follow up scheduled with dr. to discuss long term options for both stones and tumor . # paf: he was transiently in atrial fibrillation, likely caused by his sepsis and hypotension. he converted soon upon entrance to the icu. he was begun on heparin briefly for anticoagulation, but he developed a urological bleed, so the heparin was stopped. he maintained sinus rhythm on the floor with digoxin. no anticoagulation recommended in this setting because of the propensity of bleeding from bladder tumor. # hematuria: likely heparin and large bladder stone/tumor. his heparin was d/c'd and he received continuous bladder irrigation, which began to clear on . foley was discontinued without difficulty on . . # acute on crf: improved to 1.1 then jump to 1.4 o/n in setting of lasix and ketorolac. also has a component of ckd. still has good uop. . # acute on chronic diastolic heart failure -- mildly hypervolemic on discharge, probably contributing to hypoxia during exertion. plan for three days of gentle diuresis for goal of 1 liter negative over those days. . # bph: finasteride, tamsulosin. # uc: no active issues. - sulfasalazine d/c'd as there is tentative evidence that it may exacerbate lung disease and already on steroids for copd - can consider restarting sulfasalazine when respiratorily stable . medications on admission: meds from osh: lipitor 40 sulfasalazine 1g qid advair duoneb q4 flomax 0.4 qhs spiriva qd diovan 160 qd pred 10 qod beclomethasone ih guanifensin 1g qd protonix 40 qd . meds on transfer to : metoprolol 25 mg po q6h miralax *nf* 17 gram (100 %) oral daily acetaminophen 1000 mg po q6h morphine sulfate 2-4 mg iv q8h:prn pain atorvastatin 40 mg po daily oxycodone (immediate release) 5-10 mg po q6h:prn pain bisacodyl 10 mg po daily buspirone 10 mg po tid pantoprazole 40 mg po q24h chlorthalidone 25 mg po bid prochlorperazine 10 mg po/iv q6h:prn diltiazem extended-release 240 mg po bid prednisone 10 mg po daily docusate sodium 200 mg po bid salmeterol xinafoate diskus (50 mcg) 1 inh ih q12h finasteride 5 mg po daily senna 1 tab po bid:prn fluticasone propionate 110mcg 2 puff ih guaifenesin 15 ml po q6h sulfasalazine 1000 mg po qid ipratropium bromide neb 2 neb ih q6h tamsulosin 0.4 mg po hs isosorbide mononitrate (extended release) 30 mg po daily tiotropium bromide 1 cap ih daily urocit-k 10 *nf* 10 meq oral lorazepam 0.5-1 mg po/iv q4h:prn anxiety albuterol inhalation q2h:prn sob, wheeze discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 4. valsartan 80 mg tablet sig: one (1) tablet po bid (2 times a day). 5. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q4h (every 4 hours) as needed for wheezing. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. diltiazem hcl 60 mg tablet sig: one (1) tablet po qid (4 times a day). 8. prednisone 20 mg tablet sig: three (3) tablet po daily (daily): please taper over 3 weeks (60 mg po qday x 5 days, 40 mg po qday x 7 days, 20 mg po qday x 7 days then d/c). 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. ceftriaxone-dextrose (iso-osm) 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 2 days. 12. lasix 40 mg tablet sig: one (1) tablet po once a day for 2 days: for goal diuresis of approx 1 liter over two days. 13. lipitor 40 mg tablet sig: one (1) tablet po once a day. 14. flomax 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime. 15. finasteride 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: 1. e. coli bacteremia with septic shock and respiratory failure 2. urinary obstruction from nephrolithiasis s/p stent placement 3. bladder mass, awaiting biopsy for pathology 4. copd exacerbation on home oxygen 5. paroxysmal atrial fibrillation, now resolved 6. delerium 7. acute on chronic diastolic heart failure discharge condition: stable, continues to have mild delerium especially in early am hours, but improving. additionally, he has desaturation during ambulation and requires higher amount of oxygen for exertion. discharge instructions: you were hospitalized for kidney stones, but had a long hospitalization secondary to severe infection from the stones, renal failure, respiratory failure. you are being discharged to hospital level rehabilitation to continue your antibiotics and have physical therapy to regain your strenth. please follow up with your doctors as recommended below. call your primary doctor with questions or return to the emergency department with fever, chest pain, decreased urination, worsening mental status or other concerns. followup instructions: please see dr. on wednesday , 3:30pm. , , across from . please call your primary physician, . , m. to schedule follow up in weeks. please call dr. , the pulmonologist, to follow up regarding your copd in months at , e/ks-b23 , phone: fax: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube percutaneous nephrostomy without fragmentation other cystoscopy diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, stage iii (moderate) acute respiratory failure septic shock septicemia due to escherichia coli [e. coli] hydronephrosis calculus of ureter calculus of kidney obstructive chronic bronchitis with acute bronchitis other calculus in bladder 

Answer: The patient is high likely exposed to