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: sulfa(sulfonamide antibiotics) attending: chief complaint: painless jaundice major surgical or invasive procedure: - ercp with sphincterotomy and biliary stent history of present illness: 88 y.o woman with history of distal pancreatectomy, cholecystectomy and splenectomy due to cystic neoplasm who presents to the hospital from her nursing facility with 2 days of painless jaundice. the patient initially presented to the ed where with 2 days of symptoms of feeling as though she had difficulty taking pos, feeling as though she had to burp. at , her labs were notable for an ast of 73, ap of 688, tbili of 7.2. she was then referred to for surgical evaluation and ercp for likely obstructive jaundice. in the ed, initial vs were: 98.8 110 140/67 28 95% 3l. labs on admission were notable for: k of 3.2, na of 127, bicarb of 33, cre of 1.2. her abdominal labs showed mildly elevated alt/ast, alk phos of 583, tbili of 9.6 and dbili of 7.9. cbc showed an elevated wbc count of 13.3 with mild bandemia and left shift. ruq ultrasound showed increased bile duct dilation with evidence of debris in common bile duct. she received cipro/flagyl in the emergency room. review of systems: (+) per hpi (-) negative for fevers, chills, nausea, vomiting, chest pain, shortness of breath, blood in stool, change in colour of her stools or evidence of coloured stools. past medical history: afib gerd anxiety depression distal pancreatectomy and splenectomy diabetes congestive heart failure hysterectomy hip replacement mva with rle surgery social history: lives in a nursing home. denies tobacco or etoh. son is involved in her care. family history: her mother had breast cancer and coronary disease. her father had coronary artery disease and diabetes. there is no family history of dementia. physical exam: admission exam: general: sleepy, oriented x 2, in nad heent: icteric sclerae, dry mucous membranes neck: supple, jvp at 8cm cv: tachy, irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar crackles, diminished at the bases. abdomen: soft, non-distended, bowel sounds present, no organomegaly, positive gu: no foley ext: warm, well perfused, 2+ pulses, 2+ lower extremity edema bilateraly. neuro: grossly intact pertinent results: admission labs: 11:20pm blood wbc-13.3* rbc-3.93*# hgb-12.1# hct-37.8# mcv-96 mch-30.7 mchc-32.0 rdw-14.9 plt ct-273 11:20pm blood neuts-82* bands-3 lymphs-7* monos-8 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* 06:18am blood pt-14.9* ptt-25.3 inr(pt)-1.4* 08:57pm blood glucose-142* urean-30* creat-1.2* na-127* k-3.2* cl-84* hco3-33* angap-13 08:57pm blood alt-48* ast-60* alkphos-583* totbili-9.6* dirbili-7.9* indbili-1.7 08:57pm blood probnp-* 08:57pm blood lipase-30 08:57pm blood albumin-2.8* 09:01pm blood lactate-1.9 06:17am urine color- appear-hazy sp -1.016 06:17am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirub-mod urobiln-neg ph-5.0 leuks-lg 06:17am urine rbc-2 wbc-25* bacteri-many yeast-none epi-1 06:17am urine hours-random creat-112 na-34 k-56 cl-24 06:17am urine osmolal-559 discharge labs: micro: -bcx x2: ngtd -ucx: >100,000 e. coli urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. cefepime sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- 4 s ceftazidime----------- =>64 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r imaging: -cxr (): findings consistent with congestive heart failure. no pneumothorax. -ruq us (): 1. increased biliary dilatation since the prior study with debris in the common bile duct. recommend mr for further evaluation once symptoms of acute heart failure resolve. 2. right pleural effusion. 3. right renal cyst. -ercp (): findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: the major papilla was bulging with pus discharge. cannulation: cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in partial opacification. given cholangitis further contrast injection was not performed. biliary tree fluoroscopic interpretation: limited cholangiogram showed dilated cbd approximately 10mm in size. given cholangitis further contrast injectuion was not made. procedures: given the finding of large amount of pus exuding at the ampulla a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. given the finding of cholangitis a 5cm by 10fr double pig tail biliary stent was placed successfully using a oasis 10fr stent introducer kit to facilitate biliary decompression. good bile flow was noted after stent placement. impression: the major papilla was bulging with pus discharge. cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in partial opacification. given cholangitis further contrast injection was not performed. limited cholangiogram showed dilated cbd approximately 10mm in size. given cholagitis further contrast injection was not done. given the finding of large amount of pus exuding at the ampulla a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. given the finding of cholangitis a 5cm by 10fr double pig tail biliary stent was placed successfully using a oasis 10fr stent introducer kit to facilitate biliary decompression. good bile flow was noted after stent placement. recommendations: return to . npo overnight with aggressive iv hydration with lr at 75-100 cc/hr. follow for response and complications. if any abdominal pain, fever, jaundice, gastrointestinal bleeding please call ercp fellow on call () continue iv antibiotics. repeat ercp in 4 weeks for stent removal and biliary evaluation. brief hospital course: 88 y.o woman with history of distal pancreatectomy, dm who presents with obstructive jaundice who was found to have cholangitis now s/p sphincterotomy. . #cholangitis ?????? the patient had labs suggestive of cholestasis with dilation of the common bile duct to 1.2cm at admission; tbili was elevated to 9.6 with dbili of 7.9. she underwent ercp which showed pus in the bile duct, and she had a spincterotomy and biliary stent placed. her bili started to downtrend after the procedure. she was started on cipro/flagyl at admission which was switched to meropenem when she was found to have a multidrug resistant e.coli uti. at discharge, it was changed to ertapenem for ease of daily administration instead of q8 hour dosing. she will need a repeat ercp in 4 weeks to assess for improvement with a repeat cholangiogram and removal of the stent. her sensation of abd distension and 'burping' resolved after ercp. she advanced her diet fully. . #depression ?????? patient repeatedly stated in the icu that she wants to die, and seemed frustrated with her situation although she is unable to express herself. this was discussed with her sons who stated that in the past, she had made similar statements about wanting to die while in the hospital but her mood improved after discharge. she denied feeling suicidal and appeared to be at her baseline mood at discharge. . #acute on chronic diastolic congestive heart failure - she appeared volume overloaded on her chest imaging as well as on exam at admission. probnp elevated to 10,000. she was not given any significant diuresis given that she was found to have cholangitis and she was given gentle fluids for low urine output this admission. her home bumex was held in the setting of her infection and was restarted. her o2 requirement decreased to 3l without any further intervention. she was on 2l prior to admission and should continue her bumex. daily weights should be checked. . #uti - she had elevated wbcs on admission ua and ucx showed >100,000 e. coli resistant to most abx, and her abx were changed to meropenem. she should complete a 10 days course for a complicated uti. meropenem was started . . #elevated creatinine - creatinine elevated to 1.3 this admission, baseline at best during last admission in was 1.0. fena 0.28% on , although she is total body volume overloaded. she did not respond to fluid but cr remained stable at 1.3. this likely represents the development of chronic kidney disease over the past 4 years given that interval labs were unavailable. . #atrial fibrillation - chads2 score of 2, the patient is not on chronic anticoagulation at admission. hr remained well controlled on her home dose of metoprolol. we discussed anticoagulation with her pcp who stated that coumadin was not started due to a hx of falls. the patient discussed this with her cardiologist who did not recommend starting it. . #conjunctivitis - the patient had evidence of conjunctivitis in her left eye and was started on erythromycin ointment while in house. she may resume her vigamox at discharge. . #code status this admission - full code . #transitional issues . -will need repeat ercp 4 weeks from her procedure this admission (on ) medications on admission: omeprazole 20mg buspirone 5mg aspirin 81mg daily celexa 20mg daily cholecalciferol 1000mg daily os-cal 500 + d 500mg-600u daily vitamin e 400 tab qod metoprolol 25mg mvi daily bumetanide 1mg daily lisinopril 2.5mg qd nitroglycerin 0.2mg/hr transderm lovenox 40mg subq once daily amaryl 4mg daily novolin r 100u/ml vigamox 1 drop tid ranitidine 300mg daily bisacodyl rectal 1 daily prn milk of mag daily prn discharge disposition: extended care facility: life care center of discharge diagnosis: cholangitis uti discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were hospitalized for cholangitis and underwent an ercp with sphincterotomy and stent placement. you were also found to have a uti and will need a 10 day course of antibiotics. you should follow up for a repeat ercp in approximately 4 weeks. they will contact you. were hospitalized for cholangitis and underwent an ercp with sphincterotomy and stent placement. you were also found to have a uti and will need a 10 day course of antibiotics. you should follow up for a repeat ercp in approximately 4 weeks. they will contact you. followup instructions: the ercp team will contact you regarding a repeat ercp in 4 weeks. you should follow up with your pcp weeks. procedure: endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: esophageal reflux 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 hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure depressive disorder, not elsewhere classified chronic kidney disease, unspecified anxiety state, unspecified long-term (current) use of insulin other acquired absence of organ cholangitis obstruction of bile duct hip joint replacement other and unspecified escherichia coli [e. coli] acquired partial absence of pancreas conjunctivitis, unspecified 

Answer: The patient is high likely exposed to