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: depakote attending: chief complaint: respiratory failure major surgical or invasive procedure: none history of present illness: pt is a f with hx aspiration pna, g-tube, dmenetia, who was bibems after being found in nh in resp distress, with sat 60s. by report, pt had had high residuals from g-tube and a kub demonstrated an ileus. ems placed pt on a nrb and sats increased to 90%. baseline a&o x 1. no hx abd surgeries. on arrival in the ed, vitals signs: t 99.3, hr 114, bp 116/56, rr 40, sao2 95% on nrb. labs notable for a wbc 51, hct 34, plt 966, lactate 4.7 -> 3.6, and a trop 0.32 (last value 0.06 on last hospitalization). the pt was intubated fiberoptically by anesthesia given the degree of kyphoscoliosis. a l femoral cvl was placed, and a total of 3 l ns was adminsistered, as well as vanc/levaquin/zosyn. a small amount of levophed was required. a ct torso revealed multifocal pna and a ? early or partial sbo. gen was consulted for the ct scan finding, feel that this is not true sbo, recommend venting the g-tube to gravity. . on arrival in micu, pt is intubated, sedated. . ros: unable as pt is intubated. past medical history: # moderate to severe dementia # osteoporosis # chronic diastolic heart failure # mild-moderate systolic pulmonary hypertension # history of depression # malnutrition - moderate to severe, likely secondary to dementia # atrial fibrillation # aspiration pneumonia (, with complicated course with intubation, pressors, vap, tension pneumothorax from line insertion, chest tube, thrombocytopenia) social history: - ms. at of . she was married many years ago and never had any children. functional status: she at baseline is minimally oriented and interactive according to staff at . prior to her first icu admission this fall, she was able to transfer with a two person assist. now requires a lift to transfer her. family history: (from chart review) mother died of old age in her late 90's. physical exam: vs: t hr 88 bp 79/44 on 0.03 levophed rr 15 sao2 98% on 400x15x5x50% gen: frail, elderly, intubated, kyphotic heent: perrl heart: s1s2 rrr pulm: rhonchi throuhout abd: soft, nt/nd ext: no c/c/e neuro: sedated skin: large decubitus over r buttock, with purulence expressed pertinent results: admission labs: 05:12pm wbc-51.4*# rbc-3.56* hgb-11.1* hct-34.0* mcv-96 mch-31.3 mchc-32.7 rdw-14.9 05:12pm neuts-90* bands-9* lymphs-0 monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 05:12pm hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-normal polychrom-normal spherocyt-1+ envelop-2+ 05:12pm plt smr-very high plt count-966*# 05:12pm pt-13.7* ptt-32.6 inr(pt)-1.2* 05:12pm ctropnt-0.32* 05:12pm ck(cpk)-63 05:12pm glucose-157* urea n-62* creat-0.9 sodium-144 potassium-4.7 chloride-98 total co2-30 anion gap-21* 05:35pm lactate-4.7* 10:10pm lactate-3.6* . ct c/a/p - 1. multifocal air-space consolidation in the lungs with dense left lower lobe consolidation are most consistent with aspiration related pneumonia (given the peribronchovascular distribution and impaction in the left lower lobe airway). 2. stable appearance of right lower lobe pulmonary nodule. 3. moderate colonic fecal loading. 4. anasarca. 5. cholelithiasis. . cxr - extremely limited study with cardiomegaly and mild chf. ct head: 1. no acute intracranial abnormality. 2. generalized with more marked selective medial temporal atrophy, as may be seen with alzheimer disease. labs on discharge 03:36am blood wbc-5.1 rbc-2.52* hgb-7.8* hct-23.4* mcv-93 mch-30.7 mchc-33.1 rdw-15.8* plt ct-381 03:36am blood plt ct-381 03:36am blood glucose-110* urean-20 creat-0.4 na-138 k-4.5 cl-100 hco3-35* angap-8 05:00am blood alt-19 ast-37 ld(ldh)-241 alkphos-112 totbili-0.3 03:47am blood ck-mb-notdone ctropnt-0.27* 03:12am blood calcium-8.2* phos-2.7 mg-2.1 12:11pm blood type-art peep-0 fio2-40 po2-118* pco2-48* ph-7.51* caltco2-40* base xs-13 intubat-intubated vent-spontaneou microbiology: sputum culture: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): sparse growth oropharyngeal flora. escherichia coli. moderate growth. of three colonial morphologies. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- r ceftazidime----------- r ceftriaxone----------- =>64 r cefuroxime------------ =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- =>128 r piperacillin/tazo----- 8 s tobramycin------------ =>16 r trimethoprim/sulfa---- <=1 s urine culture: no growth brief hospital course: ms. is a year old female with past medical history of dementia, atrial fibrillatin, sacral decubitus ulcer admitted from nursing home due to respiratory distress due to aspiration pneumonia and sepsis. 1)aspiration pneumonia and sepsis: on admission she had respiratory failure and sepsis most likely aspiration pneumonia given multifocal infiltrates on chest ct from . she was initially treated for healthcare associated pneumonia with vancomycin, zosyn and levofloxacin and she completed an eight day course. her sputum ended up growing esbl ecoli so she was started on meropenem and completed an eight day course. she was also diuresed with 5-10mg iv lasix and her ventillator settings were weaned. on she was successfully extubated after passing a spontaneous breathing trial. of note her rsbi was 110-120 for several days preceeding extubation. she did well post extubation without any complications. due to concern for aspiration she was kept npo throughout her hospitalization and was given tube feeds for nutrition. given the near certainty that oral feeding will result in recurrant aspiration pneumonia and sepsis, she should be not be given anything by mouth. following extubation she was discharged back to her nursing facility. 2)sacral decubitus ulcer: stage iv, with frank purulence on admission. initially concerning for possible cause of sepsis on admission, given that one set of blood cultures from admission were positive for gpc's. this ended up growing coagulase negative staph in one bottle only with all other blood cultures throughout her admission negative, indicating that this was most likely a contaminant. she was seen by plastic surgery during her admission who did one bedside debridement. she was also followed by the wound care consult service during her admission. she had a kinair mattress for pressure relief throughout her hospitalization. she had dressing changes daily with packing of the large sacral decubitus with antimicrobial kerlex daily. she also has two areas of break down on the right gluteus and one on the left gluteus treated with mepilex dressing. 3)hx afib: she was in sinus rhythm throughout her admission, without any episodes of afib with rvr. she was continued on her outpatient dose of amiodarone. she was also treated with full dose aspirin for thromboprophylaxis. 4) nutrition - she was continued on tube feeds via her peg tube throughout her admission as recommended by the nutrition service. she should be kept npo due to high risk for aspiration. 5) dementia - during her admission her namenda was held due to severe illness. this can be restarted on returning to the nursing facility. 6) code status - during her admission her was contact numerous times and her code status was changed to dnr/dni. medications on admission: - amiodarone 200 qd - mvi - namenda 10 q am - namenda 5 qhs - free h20 200cc q 6 h via g - prevacid 30 daily via g - senna 1 tab qhs discharge medications: 1. amiodarone 200 mg tablet : one (1) tablet po daily (daily): administer via peg tube. tablet(s) 2. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection (2 times a day). 3. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 4. aspirin 325 mg tablet : one (1) tablet po daily (daily): via peg tube. 5. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 6. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 7. acetaminophen 500 mg tablet : one (1) tablet po q6h (every 6 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) nebulizer inhalation q4h (every 4 hours) as needed. 9. namenda 10 mg/5 ml solution : ten (10) mg po qam. 10. namenda 10 mg/5 ml solution : five (5) mg po qpm. discharge disposition: extended care facility: of discharge diagnosis: aspiration pneumonia with esbl ecoli sepsis stage iv sacral decubitus ulcer dementia discharge condition: stable oriented to person only, respiratory rate in the 20's, cooperative discharge instructions: you were admitted to the hospital for aspiration pneumonia and sepsis (very severe infection). you were intubated due to difficulty breathing. you were treated with antibiotics and you slowly improved. you were extubated after approximately two weeks. you also have a large ulcer on your buttocks. this was cleaned twice daily and you were also evaluated by the plastic surgeons who removed some of the dead tissue. your pneumonia is likely due to food going down the wrong tube into your lungs instead of your stomach. due to the risk of this happening again, you should not eat anything. you should get your nutrition by feeding through the tube in your stomach. you were discharged on the same medications that you were on prior to your admission. you completed your antibiotics prior to your discharge. please call your doctor or return to the hospital if you experience fevers, difficulty breathing, low blood pressure or other concerning symptoms. followup instructions: please continue to follow with the primary care doctor at your nursing facility. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy arterial catheterization nonexcisional debridement of wound, infection or burn diagnoses: acidosis subendocardial infarction, initial episode of care anemia, unspecified congestive heart failure, unspecified unspecified septicemia severe sepsis atrial fibrillation other chronic pulmonary heart diseases hypopotassemia constipation, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis osteoporosis, unspecified septic shock pressure ulcer, buttock pneumonia due to escherichia coli [e. coli] alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia scoliosis [and kyphoscoliosis], idiopathic chronic diastolic heart failure pressure ulcer, stage iv nutritional marasmus attention to gastrostomy other musculoskeletal symptoms referable to limbs 

Answer: The patient is high likely exposed to