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: lipitor attending: chief complaint: ventricular tachycardia arrest major surgical or invasive procedure: electrophysiology study history of present illness: mrs. is a 65 year-old woman with cad s/p cabg with post-op course complicated by pnemothorax, afib and pleural effusions with readmission for pneumonia/effusions s/p vats and s/p trach peg for persistant respiratory failure. she was dischared to ltac on and was being actively diuresed there with 40mg iv lasix and having received an additional 40mg iv on for dyspnea associated with e/o chf on cxr. today she was noted to be in vtach and c/o chest pressure. she became pulsless and received one synchronized shock at 300 j with prompt return of sinus rhythm and spontaneous ciruculation. she was transfered to the ed where initial vitals were hr 79 bp 110/33 rr 22 o2sat 100 on vent. in the ed, she was transiently hypotensive and responsed ro 1l ivf. given her hypotension, cultures were drawn and broad spectrum antibiotics initiated. a femoral line was placed (given elevated inr and trach). a bedside ultrasound by the ed resident was notable for what appeared to be global hypokinesis and a full ivc. she was transferred to the icu for further care. vitals on transfer were hr 80 and bp 83/33. mag at rehab was 1.6. ecg showed a paced rhythm at 80 with lvh and < depressions in v3-v6. . on arrival here she is alert and oriented. she reports minimal chest pressure which is present chronically. she denies recent fevers/chills or any other symptoms of note. she reports that the only significant change was realtively aggressive diuresis with iv lasix over the past day and transfusion of 1 unit prbcs for anemia with additional lasix. her respiratory status is at baseline. . patient has had a complicated course recently which began in when she presented to the ed with anginal symptoms. work-up at that time revealed 3 vessel disease and 90% in-stent stenosis of lcx. underwent cabg on with lima to lad, svg to rca and svg to om. pt transferred to cvicu post-procedure with course complicated by a right-sided pleural effusion requiring a thoracentesis and complete reexpansion of her right lung, multiple pneumothoraces and subcutaneous emphysema requiring reintubation, and intermittent episodes of rapid atrial fibrillation alternating with periods of junctional rhythm requiring pacemarker placement. patient was discharged to rehab and was readmitted on with loculated left sided pleural effusion requiring left thoracotomy and decortication with hospital course complicated by hypoxic respiratory failure thought secondary to pneumonia now s/p percutaneous tracheostomy tube and percutaneous endoscopic gastrostomy tube. she was discharged to rehab macu on . her active problems there included: --hypokelmia --loose stools on vanc po, cdiff pending --anxiety on ativan prn --supratherapeutic inr, coumadin held --anemia: ob + stool --metabolic alkalosis --delerium, improved on haldol --respiratory failure with complicated pleural effusions, cxr with bilateral fibrosis, effusions --systolic chf on aldactone, metoprolol, amio reduced and lopressor increased on --candidiasis with catheter tip positive on fluconazole --anasarca, albumin 1.8 . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: *cad with des to lcx in , s/p cabg (lima-lad, svg-rca, svg-om) *pulmonary emoblism (vte) in ' on longterm low-dose coumadin *hodgkin's disease stage 2 in ' treated with total body radiation c/b functional asplenism and radiation induced ovarian failure s/p total hysterectomy and estradiol therapy *reactive airways disease/pulmonary fibrosis *multiple pnas, most recently in requiring icu care for sepsis/hypotension *hypothyroidism *supraventricular tachycardia (presumably afib) *gerd *right chest lentigo *h/ /hsv esophagitis in setting of being on steroids (off since summer ) social history: she is a retired school administrator. she is independent and performs adls without limitation. physically, she has difficulty climbing stairs and hills. no tob or drugs. occasional etoh, but rarely. married and lives with husband in , ma. retired school administrator family history: no family history of lung or cardiac diseases. nc for cad, scd or arrhythmia. mother: maternal gm: uterine cancer physical exam: physical exam on admission: gen: well appearing, awake, alert, trach in place heent: eomi, perrla neck: trach in place with no secretions cv: rrr, nl s1/s2, no m/r/g chest: decreased breath sounds at bases, diffuse rhonchi and end-expiratory wheezes, no rales abd: peg in place with dressing, no discharge, soft, nt/nd, bs+ ext: trace pedal edema . physical exam on discharge: gen: well-appearing, awake, alert. conversant. heent: eomi, perrla neck: trach in place with passy muir valve in use. cv: rrr, nl s1/s2, no m/r/g chest: decreased breath sounds at bases with faint crackles, soft rhonchi in low/mid lung fields. abd: peg in place with dressing, no discharge, soft, nt/nd, bs+ ext: 2+ pulses without edema. neuro: aox3. mae. pertinent results: laboratory data: . cbc --------------- 09:25pm blood wbc-12.6* rbc-3.85*# hgb-11.1*# hct-34.4*# mcv-89 mch-28.8 mchc-32.3 rdw-16.1* plt ct-522*# 04:03am blood wbc-7.8 rbc-3.28* hgb-9.8* hct-29.3* mcv-89 mch-30.0 mchc-33.5 rdw-15.8* plt ct-520* 09:25pm blood neuts-85.8* lymphs-7.8* monos-3.7 eos-2.4 baso-0.2 03:12am blood neuts-78* bands-1 lymphs-6* monos-13* eos-1 baso-0 atyps-0 metas-1* myelos-0 coag panel ----------------- 09:25pm blood pt-50.0* ptt-36.6* inr(pt)-5.3* 03:09am blood pt-13.4 ptt-23.3 inr(pt)-1.1 complete metabolic panel ----------------- 09:25pm blood glucose-150* urean-22* creat-0.8 na-141 k-4.0 cl-96 hco3-34* angap-15 09:25pm blood calcium-8.4 phos-4.1# mg-1.8 04:03am blood glucose-82 urean-25* creat-1.0 na-137 k-4.5 cl-99 hco3-30 angap-13 04:03am blood calcium-8.8 phos-3.4 mg-2.1 liver tests ----------------- 05:09am blood alt-50* ast-48* alkphos-271* totbili-0.4 03:09am blood alt-47* ast-40 alkphos-258* totbili-0.3 urine tests ----------------- 09:21pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.5 leuks-neg 09:21pm urine color-yellow appear-clear sp -1.016 09:21pm urine rbc-14* wbc-2 bacteri-few yeast-none epi-0 microbiological data **final report ** urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r linezolid------------- 2 s nitrofurantoin-------- 128 r tetracycline---------- =>16 r vancomycin------------ =>32 r . . . **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. moderate growth. piperacillin/tazobactam sensitivity testing performed by . klebsiella pneumoniae. sparse growth. piperacillin/tazobactam sensitivity testing confirmed by . 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 _________________________________________________________ pseudomonas aeruginosa | klebsiella pneumoniae | | ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- 16 i ceftazidime----------- 32 r =>64 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ 8 i <=1 s meropenem------------- 4 s <=0.25 s piperacillin/tazo----- i 16 s tobramycin------------ <=1 s =>16 r trimethoprim/sulfa---- <=1 s . . . time taken not noted log-in date/time: 9:00 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): commensal respiratory flora absent. pseudomonas aeruginosa. sparse growth. piperacillin/tazobactam sensitivity testing performed by . doripenem sensitivity requested by dr. on . klebsiella pneumoniae. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | klebsiella pneumoniae | | ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- 16 i ceftazidime----------- 16 i =>64 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ 8 i <=1 s meropenem------------- 8 i <=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s =>16 r trimethoprim/sulfa---- <=1 s cxr frontal chest radiograph: right-sided picc line and tracheostomy tube are in unchanged position. cardiomediastinal silhouette is stable. dual lead left-sided pacer with lead overlying the expected locations of the right atrium and right ventricle is noted. multifocal patchy opacities are mildly improved, especially in the right lower lung zone. small left-sided pleural effusion with associated atelectasis and smaller right-sided pleural effusion are stable. no pneumothorax is appreciated. impression: mildly improving multifocal parenchymal opacities. ekg : atrial paced rhythm with intrinsic ventricular conduction. inferiora and anterolateral st-t wave changes. cannot exclude ischemia. q-t interval prolongation. compared to the previous tracing of the anteroseptal st-t wave changes have improved. brief hospital course: 65 yo f with recent afib, cabg in , s/p trach and peg secondary to repeated respiratory failure, presented on s/p pulseless arrest, course complicated by klebsiella and pseudomonas pneumonia. pneumonia: patient became febrile on icu day # 2. she was started broadly on vap protocol with vancomycin/zosyn/tobramycin. tobramycin was discontinued and she was switched to meropenem 2 g every 8 hours, infused over 3 hours, for pseudomonas and klebsiella pneumonia. id was consulted and based on doripenem sensitivities, she was swtiched to doripenem for 2 days. however, the final recommendation was to switch patient back to meropenem and resend doripenem sensitivities. these sensitivities were pending at the time of discharge. thus, she is being discharged on 2 g meropenem every 8 hours, infused over 3 hours. we recommend that rehab call the micro in the next 1-2 days at for the results on the doripenem sensitivities. if the mic of doripenem is less than the mic of meropenem ( less than 8), we recommend that rehab switch back to doripenem 1 g every 8 hours infused over 4 hours for the same 14 day duration. if the patient shows signs of intolerance to high dose meropenem (i.e. persistent nausea), can decrease dose to one gram every 8 hours infused over 3 hours. day 1 of antibiotics was for a total 14 day course. *continue antibiotics up to and including *will need to conitnue flagyl for c.diff prophylaxis per below. respiratory compromise: patient has chronic trach in place, on trach mask with intermittent pressure support ventilation. she alternated between pressure support and trach collar, progressively spending more time on trach collar. she usually rests on the vent overnight; however, on final night in the hospital, she was able to stay off the ventilator and maintained adequate respiratory status on the trach collar. *continue intermittent pressure support for respiratory assitance. nausea: patient began to develop nausea on last several days of admission. this nausea was controlled with zofran 8 mg po every 8 hours. we recommend that rehan hold all nonessential medications (multivitamins, vitamin supplementation) in the short term, and then restart slowly. reactive airways disease / pulmonary fibrosis: secondary to radiation from hodgkin??????s. chronic fibrotic changes radiographically. she was continued on albuterol and ipratropium nebs. status post pulseless arrest: s/p dccv with return of nsr. initially, felt to be ventricular tachycardia (vt). went to ep study, could not induce vt, induced 1:1 atrial flutter, which ep felt was the rhythm responsible for the arrest. device not placed and pacer remained. she was continued on amiodarone. atrial fibrillation: continued on amiodarone, metoprolol, and coumadin. pacer: ep interrogated pacer during above study, and changed pacer to be a-paced, not v-paced. nutrition: patient initially was on tube feeds cycled at night. due to poor po caloric intake during the day, decided to run the tube feeds continuously at 40/hr. tube feed setting = isosource 1.5 cal full strength; starting rate: 10 ml/hr; advance rate by 10 ml q4h goal rate: 40 ml/hr residual check: q4h hold feeding for residual >= : 200 ml flush w/ 50 ml water q6h clostridium difficile: patient was on po vancomycin for clostridium difficile prophylaxis. c. diff toxin x 2 and c diff pcr negative. id service recommended continuation of po vanco through final dose of doripenem, which is . following this date, po vancomycin should be discontinued if there are no signs of symptoms of a c. diff infection. chronic systolic heart failure: ef~35%, likely ischemic cardiomyopathy. required iv lasix for several days for pulmonary edema. once patient euvolemic, she was switched to her home dose lasix 40mg po once a day. vancomycin resistant enterococcus in urine: patient started on linezolid on . was discontinued on per id recs as inital urnalysis was negative and subsequent cultures were also negative. cad: s/p pci (des to lcx in ) s/p cabg in 3/. patient continued on metoprolol at a decreased dose of 25 , continued on lisinopril. microcytic anemia: previously work-up consisetent with anemia of chronic disease. has had guaiac positive stools in past, but no signs of acute bleeding. she required one transfusion of 1 unit for hct 24, which appropriately increased. hypothyroidism: continued on levothryoxine medications on admission: atenolol 25 qam lipitor 40 qhs prilosec 20mg qam xalatan 1 drop both eyes hs asa 81 daily celexa 20mg qam timolol 1 drop r eye discharge medications: 1. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 2. acetaminophen 650 mg/20.3 ml solution : one (1) po q6h (every 6 hours) as needed for pain/fever. 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q4h (every 4 hours). 4. amiodarone 200 mg tablet : one (1) tablet po daily (daily). 5. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane tid (3 times a day). 6. cyanocobalamin (vitamin b-12) 100 mcg tablet : one (1) tablet po daily (daily). 7. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid : one (1) po bid (2 times a day). 8. folic acid 1 mg tablet : one (1) tablet po daily (daily). 9. furosemide 40 mg tablet : one (1) tablet po daily (daily). 10. levothyroxine 100 mcg tablet : one (1) tablet po daily (daily). 11. lisinopril 5 mg tablet : one (1) tablet po once a day. 12. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 14. potassium chloride 20 meq packet : two (2) po once a day. 15. spironolactone 25 mg tablet : one (1) tablet po daily (daily). 16. vancomycin 125 mg capsule : one (1) capsule po once a day: please discontinue after course of doripenem last day = . 17. atrovent hfa 17 mcg/actuation hfa aerosol inhaler : one (1) inhalation every 4-6 hours as needed for shortness of breath or wheezing. 18. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 19. morphine 10 mg/5 ml solution : one (1) po q4h (every 4 hours) as needed for pain. 20. ondansetron 4 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 21. warfarin 2 mg tablet : one (1) tablet po once daily at 4 pm. 22. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily) as needed for pain. 23. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 24. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 25. prochlorperazine maleate 5 mg tablet : one (1) tablet po every 6-8 hours as needed for nausea. 26. meropenem 1 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours): last day of antibiotics through . discharge disposition: extended care facility: for the aged - macu discharge diagnosis: pulseless arrest pseudomonas and klebsiella pneumonia 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: ms. , . you were seen in the hospital after you had a pulseless cardiac arrest, which was treated with an electrical shock. you were evaluated by the cardiologists, who induced a rhythm called atrial flutter, which did not warrant an implantable defibrillator. you will continue your amiodarone and coumadin. . you also developed a pneumonia. we treated you with several antibiotics and you will continue to take an antibiotic called doripenem for a total of 14 days. . we made the following changes to your medications: started meropenem stopped fluconazole increased coumadin changed tylenol to 650 every 6 hours as needed stopped lasix 40 mg iv bid started lasix 40 mg po once a day stopped omeprazole started pantoprazole started lidocaine patch . it has been a pleasure taking care of you ms. ! followup instructions: department: medical specialties when: tuesday at 9:00 am with: dr. & dr. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 9:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: gastroenterology when: monday at 11:15 am with: , m.d. building: lm campus: west best parking: garage md, procedure: catheter based invasive electrophysiologic testing central venous catheter placement with guidance diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status atrial flutter pneumonia due to pseudomonas cardiac arrest cardiac pacemaker in situ pneumonia due to klebsiella pneumoniae gastrostomy status tracheostomy status 

Answer: The patient is high likely exposed to