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: patient recorded as having no known allergies to drugs attending: chief complaint: hypoxia major surgical or invasive procedure: mechanical ventilation peg tube placement picc history of present illness: 83 year-old man with a pmh of htn and hld who developed abrupt onset l sided weakness and was taken to an osh and given tpa and then transfered to . in the ed he has a persistent dense l hemiplegia as well as significant dysarthria. repeat imaging showed no bleeding or vessel obstruction, therefore no arterial interventions are available. he continued to have l hemiplegia. he did not pass a speech and swallow evaluation and continued to have slurred speech. he was started on tube feeds via ngt. per his family, he did not speak, but was communicating with them up to 1 day prior to his icu transfer. on the day prior to transfer, he was less communicative. on morning of he developed hypoxia with saturation of 79% on room air. he was suctioned with return of tube feedings. he was placed on nrb with oxygen saturation of 90-95% on the nrb. an abg was drawn with the following numbers 7.44/35/67 and he was subsequently transferred to the micu. upon arrival to the micu patient was on nrb with oxygen saturation of 95%, rr 40s, increased work of breathing, tachycardic 110-130s. decision was made to intubate patient. past medical history: hypertension gout gored by bull x 2 oa bph social history: unable to obtain family history: nc physical exam: vitals: 98.3 160/80 75 40 88ra (-> 98ra) general: alert, speech dysarthric, oriented to , unable to express date, tachypneic heent: sclerae anicteric lungs: diminished with rales at left base, remainder cta cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: nabs, soft, nd/nt. ext: warm, well perfused. 2+ pitting edema in all ext, ue>le. wiggles right fingers/toes, no movement on left extremities. pertinent results: micro: positve sputum cultures from , , , , : gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): sparse growth oropharyngeal flora. staph aureus coag +. moderate growth. of two colonial morphologies. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s 12:05 pm bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. smear reviewed; results confirmed. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. 10,000-100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s fungal culture (preliminary): no fungus isolated. 3:44 am stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. blood cultures: , , , , , , , , , , , cardiology report ecg study date of 8:12:38 pm sinus bradycardia with 1st degree a-v block left axis deviation rbbb with left anterior fascicular block no previous tracing available for comparison ct head impression: 1. known acute right hemipontine infarction is not well-visualized on the ct. the perfusion of the mca vascular territory is normal. 2. at least 75% diameter stenosis of the proximal portion of the right internal carotid artery, just distal to the bifurcation; this could be characterized further by focused son. 3. retropharyngeal course of the more distal cervical right ica, a normal variant. 4. mural irregularities involving both vertebral arteries with calcification at the origin of the right vertebral artery. 5. left frontal encephalomalacia, most likely related to old infarct. mri head impression: 1. acute infarction of much of the right hemipons, likely on the basis of pontine perforating vessel occlusion. 2. old left frontal and chronic microvascular infarction, with significant central atrophy. 3. normal mr angiogram of the cranial vessels. ct head impression: evolution of right pontine infarction. no intracranial hemorrhage. ct chest/abd/pelvis: 1. no pe or aortic dissection although evaluation for subsegmental pe is limited due to motion. 2. significant left lower lobe collapse, bilateral effusions. 3. traumatic inflation of foley catheter balloon in the penile urethra. 4. hypoattenuating collection in the bladder likely related to hematoma. 5. appearance of gastrostomy tube is suspicious for traversing a loop of transverse colon prior to entering the stomach. abd x-ray impression: no evidence of contrast extravasation or free air. tte the left atrium is elongated. no thrombus/mass is seen in the body of the left atrium. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. cxr a single portable radiograph of the chest demonstrates a small-to-moderate left-sided effusion. there is bibasilar atelectasis. assessment is limited by respiratory motion. appearance of the heart and lungs is similar to that seen on the chest radiograph obtained 10 hours prior. right-sided picc is unchanged as well. brief hospital course: this is an 83 yom with recent right pontine stroke who was initially in the neuro icu who was transferred for aspiration. now s/p peg placement course complicated by aspiration pneumonia, now with new foley trauma, acute renal failure, and peg misplacement leading to respiratory distress and relative hypotension now extubated and clinically improving. # right hemi-pontine infarction: 83 year-old man presented to osh with abrupt onset l sided weakness and dysarthria, given tpa and transfered to , where he was found to have a large r pontine cva. in the ed he had a persistent dense l hemiplegia as well as significant dysarthria. repeat imaging showed no bleeding or vessel obstruction, therefore no arterial interventions were available. he continued to have l hemiplegia. he did not pass a speech and swallow evaluation and continued to have slurred speech. his course was complicated by aspiration pneumonia, hematuria secondary to foley trauma. he should be continued on asa, statin and bp control with metoprolol (goal sbp 120-160). the patient remains a high aspiration risk given his stroke. # aspiration pneumonia/respiratory failure: after large r pontine cva patient had persistent dense l hemiplegia as well as significant dysarthria. he did not pass a speech and swallow evaluation and continued to have slurred speech. he was started on tube feeds via ngt. on morning of he developed hypoxia with saturation of 79% on room air. he was suctioned with return of tube feedings. he was placed on nrb with oxygen saturation of 90-95% on the nrb. an abg was drawn with the following numbers 7.44/35/67 and he was subsequently transferred to the micu. upon arrival to the micu patient was on nrb with oxygen saturation of 95%, rr 40s, increased work of breathing, tachycardic 110-130s. decision was made to intubate patient. he was started on vancomycin and cipro/flagyl . cxr initially c/w pneumonitis that cleared, however then developed new infiltrate c/w asp pna. the patient susequently grew mrsa from his sputum and was continued on vancomycin for a 10 day course. the patient improved and was extubated on am. he weaned to 1 l nc with resp alkalosis and intermittent tachypnea with central etiology. the patient remains tachypenic in the 30-40. his cxr from showed small-to-moderate left-sided effusion. there is bibasilar atelectasis. the patient will be continued on vancomycin for a 10 day course ending . the patient continues to be a high risk for aspiration given his stroke. # peg placement ?????? the peg was placed on . it was incidentally found to traverse through transverse colon and then to enter the stomach on ct obtained to eval pelvis for hematuria on . surgery was made a aware and nothing to do at this time. there was no evidence of extravasation of contrast on xray or ct. given the patient had recurrent fevers and peg placement the pt was started on cipro/flagyl for course planned to end on . # persistent fevers: sputum persistenly growing mrsa, on vancomycin, however fevers also occurred in setting of significant acute gouty flare, improving on colchicine. fever trending down. cont abx as above #. hematuria: patient developed hematuria with clots and urology consulted on . the patient was given 3 units prbcs. he was found to have hematoma in bladder from foley trauma and a cystocopy revealed prostatic trauma. the patient was started on cbi and continued until . if the patient continues to have hematuria he can be restarted on cbi. plan at discharge is for discontinuation of the foley followed by foley trial once patient has clear urine for 48 hours. # coffee grounds from og tube: the patient was noted to have one episode of coffee ground from his og tube. he was started on iv ppi . this is likely secondary to stress ulceration. he as not had any subsequent episodes and his hct has remained stable. ppi was changed to once daily. # code status: during the patient's hospitalization he was made dnr/dni. medications on admission: - allopurinol 100mg po bid - atenolol 50mg po qd - colchicine 0.6mg po qd - (?) detrol la 2mg po qd - (?) gemfibrozil 600mg po bid discharge medications: 1. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 2. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 3. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 4. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 5. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 6. oxybutynin chloride 5 mg tablet : one (1) tablet po tid (3 times a day). 7. insulin regular human 100 unit/ml solution : as directed injection asdir (as directed). 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 2-4 puffs inhalation q6h (every 6 hours) as needed. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed. 10. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed. 11. allopurinol 100 mg tablet : one (1) tablet po bid (2 times a day). 12. acetaminophen 160 mg/5 ml solution : six (6) po q6h (every 6 hours). 13. ciprofloxacin 500 mg tablet : one (1) tablet po q12h (every 12 hours) for 3 days: per peg. 14. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 3 days: per peg. 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 16. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 17. vancomycin 1,000 mg recon soln : 1250 (1250) mg intravenous every twelve (12) hours for 10 days: end date . 18. metoprolol succinate 200 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po once a day. 19. metoprolol succinate 50 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po once a day. discharge disposition: extended care facility: rehab hospital discharge diagnosis: primary: right pontine stroke with left hemiparesis respiratory failure aspiration pneumonia traumatic hematuria anemia . secondary: hypertension gout oa bph discharge condition: stable, tachypneic with rr 30-40, normotensive, left sided weakness and dysarthria discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted to because of a large stroke. you were treated at an outside hospital and transferred here. your course was complicated by an aspiration pneumonia that you received antibiotics for. you also had bleeding from your bladder after a catheter was placed. you received blood transfusions and your blood level remained stable. you also had a peg tube placed for feeding that was found to have gone through your transverese colon then to your stomach. a x-ray and ct scan showed that there was no leakage. you were treated with antibiotics to prevent infection. please follow the medications prescribed below. please follow up with the appointments below. please call your pcp or go to the ed if you experience chest pain, palpitations, shortness of breath, nausea, vomiting, fevers, chills, or other concerning symptoms. followup instructions: it is recommended that you follow-up with your pcp weeks following discharge from rehab. pcp: , . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] closed [endoscopic] biopsy of bronchus other cystoscopy transfusion of packed cells irrigation of other indwelling urinary catheter diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) accidental puncture or laceration during a procedure, not elsewhere classified hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus carrier or suspected carrier of methicillin resistant staphylococcus aureus cerebral embolism with cerebral infarction hematemesis injury to bladder and urethra, without mention of open wound into cavity urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure dehydration other diseases of trachea and bronchus methicillin resistant pneumonia due to staphylococcus aureus hemiplegia, unspecified, affecting nondominant side 

Answer: The patient is high likely exposed to