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: ibuprofen / terbinafine / iv dye, iodine containing contrast media attending: chief complaint: chest wall pain major surgical or invasive procedure: 1) ir guided fluid collection drainage x2 2) ir guided aspiration 3) picc line placement 4) i&d by plastics 5) chest washout by plastics 6) sternal debridement, pectoralis advancement (bilateral) and primary closure with retention sutures. history of present illness: 52m with a history of mi (w/stents ??????09 and cabg . ??????09) p/w a week of reproducible right sided chest pain, recently admitted for similar symptoms and ruled out for acs in . he reports that 5 days pta he began to have significant right sided chest pain that is tender to palpation focally, including over the chest wound. worse with movement and breathing. pt noticed a swelling ??????pimple?????? in the area of his scar last week. he has had fevers to 101f w/ chills over the past two days (mostly at night) with a nonproductive cough and shortness of breath due to chest wall pain. s/p cabg course was complicated by a sternal wound dehiscence and multiple abscesses which required surgical drainage. pt has been free of angina. at baseline, he does have some mild shortness of breath when climbing up stairs at his apartment, but he is able to make it up the five flights of stairs multiple times a day. denies abdominal pain, n/v, sob, le edema, ha, stiff neck. . in the ed, vital signs as follows: hr: 88 bp: 127/71 rr: 14 o2: 99% . in the ed had a chest xray & labs drawn. he was started on iv ceftriaxone & vancomycin. past medical history: - coronary artery disease s/p pci , 2-vessel cabg (lima to lad, svg to diag) c/b sternal dehiscence requiring debridment, multiple wire removals & plating, & bilateraly pectoralis flaps in , c/b sternal abscess s/p i&d - chronic pancreatitis - dm - htn - erectile dysfunction - r shoulder adhesive capsulitis s/p rotator cuff & biceps impingement, now s/p surgery - s/p c4-c5 fusion - multiple chest wall infections social history: patient unemployed since . h/o ivdu and cocaine, reports being clean x4yrs; 40+ pk-yr history of tobacco, continues to smoke family history: mother with lung cancer, deceased in and aunt and uncle with lung cancer. father unknown, he lives in and the patient is not in contact with him. physical exam: admission gen: sitting up in bed in nad. heent: perrl. eomi. op clear. neck: supple, no lad. no jvd. cor: +s1s2, rrr, no m/g/r. pulm: ctab, slight inspiratory crackles over right base. : + nabs in 4q, soft ntnd ext: wwp, dp + bilaterally. no c/c/e neuro: cniii-xii intact. maee. strength 5/5 bilaterally throughout. skin: area of diffuse erythema (no demarcation), warmth, & swelling over right pectoral muscle. no induration or fluctuance. midline sternotomy scar with crusted/scabbed pustule. no dehiscence evident pertinent results: radiology: ct chest w/o contrast 1.new large pre- and right parasternal collection with small intrathoracic component as described. because of the lack of intravenous contrast administration, differentiation between and inflammatory phlegmon vs abscess was limited. 2.previous bone changes including fragmentation, demineralization and non-united post-sternotomy changes are unchanged. 3.multiple lung nodules stable since . no new lung nodules of concern. follow-up ct is recommended at one year to monitor stability . radiology report pleural asp by radiologist study date of 3:59 pm impression: technically successful aspiration of midline collection containing 46 ml of purulent fluid. aspiration of the right-sided anterior chest wall collection was not possible. sample sent for microbiological analysis. . radiology report chest u.s. study date of 3:04 pm impression: resolution of the previously drained pre sternal fluid collection with a persistent right parasternal fluid collection noted more superiorly, as described. . radiology report guidance for abscess () study date of 2:39 pm impression: uncomplicated placement of an 8 french pigtail catheter to the presternal fluid collection. 30 cc of frank pus was aspirated and sample was sent to the laboratory. . radiology report unilat up ext veins us right study date of 11:04 am impression: no dvt. . pathology: pending . microbiology: 4:30 pm abscess source: chest abscess. **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): work-up per dr ()--including doxy and bactrim. staphylococcus, coagulase negative. rare growth. sensitivity testing performed by sensititre. sensitive to clindamycin mic of <=0.12 mcg/ml. sensitive to tetracycline mic of <=2 mcg/ml. coag neg staph does not require contact precautions, regardless of resistance 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 _________________________________________________________ staphylococcus, coagulase negative | clindamycin----------- s erythromycin----------<=0.25 s gentamicin------------ <=2 s levofloxacin---------- =>16 r oxacillin------------- =>16 r rifampin-------------- <=0.5 s tetracycline---------- s trimethoprim/sulfa---- =>8 r vancomycin------------ 2 s anaerobic culture (final ): no anaerobes isolated. . 12:53 pm tissue 3rd rib. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): reported to and read back by dr. @ 1055a, . due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. staphylococcus, coagulase negative. rare growth of four colonial morphologies. anaerobic culture (final ): no anaerobes isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): . fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): no fungal elements seen. 03:20pm wbc-10.2 rbc-3.62* hgb-11.1* hct-31.3* mcv-86 mch-30.6 mchc-35.4* rdw-13.9 03:20pm neuts-81.4* lymphs-12.1* monos-4.8 eos-1.3 basos-0.5 03:20pm plt count-423 03:20pm ctropnt-<0.01 03:20pm glucose-318* urea n-19 creat-1.3* sodium-131* potassium-5.1 chloride-97 total co2-24 anion gap-15 03:33pm lactate-1.6 05:22pm d-dimer-462 brief hospital course: hospital course 52yo m pmhx cad s/p cabg complicated by sternal osteomyelitis, mrsa abscess presenting w/ new anterior chest wall fluid collection, s/p drainage, course complicated by icu stay for hypotension, ir draingage and iv abx treatment on the floor, and washout by plastics. . neuro: patient had no signs or symptoms of neurological impairment. he is alert and oriented during his entire hospital stay. the patient had significant pain requirements during his hospital stay. the patient was given iv dilaudid initially for his pain. he was continued on his home dose of ms contin 30 mg q12h. postoperatively the patient was started on a pca pump for approximately 24 hours. after which he was transitioned to oral opiate analgesics including p.o. oxycodone. however the patient did not do well with the oral oxycodone and chronic pain service was consulted. the patient was switched to p.o. dye lauded 46 kg q.3 h. as needed for pain the patient was discharged with a prescription for oral dilaudid and orders to continue his prescription for oral ms contin as directed. cardio: initially the patient was admitted for chest pain. his history and physical exam was atypical for acute coronary syndrome and his initial troponin was negative. during his stay, , patient did develop hypotension in the setting of sepsis. the patient was transferred to the intensive care unit where he received iv antibiotics, iv fluids, and pressor support. the patient's blood pressure stabilized and the iv pressors were weaned off. the patient was transferred back to the floor after he was hemodynamically stable. on the floor and postoperatively the patient's vital signs were monitored and did not require interventions for hypotension. the patient was hemodynamically stable at the time of his discharge. the patient does have history of coronary artery disease status post coronary artery bypass grafting. the patient was continued on his daily aspirin regimen. respiratory: patient did not have any planes of respiratory distress during his admission. in the emergency department the chest x-ray was negative for infiltrate there is no evidence of pneumonia. during his icu stay the patient did not require intubation and his o2 saturation was maintained on low levels of supplemental oxygen. postoperatively the patient was encouraged to ambulate her early as well as use incentive spirometry to avoid atelectasis and pneumonia. gastrointestinal: the patient did not have any gastrointestinal complaints. he was maintained on a diabetic diet and his diet was advanced as tolerated post operatively. genitourinary: the patient was admitted with acute kidney injury most likely secondary to hypo-bulimia in the setting of sepsis. his creatinine improved with iv fluids. he had normal urinary output. foley catheter was inserted during his icu stay as well intraoperatively. no complications were associated with a foley catheter. the patient was discharged with no difficulty voiding. hematologic: during his hospital stay the patient's hematocrit decreased with a nadir of 23. patient was transfused 2 units packed red blood cells prior to his second operation. there is no complications associated with the transfusion. the patient had appropriate increasing hematocrit was stable on discharge. the patient's etiology of his anemia is most secondary to surgery. mcv was normal. there is no evidence of gastrointestinal bleeding infectious disease: patient was admitted with an anterior chest wall collection suspect to be infectious in etiology. he has a history of chronic osteomyelitis in the past. during his admission he was transferred to the icu for suspected sepsis. in emergency department the patient was given broad-spectrum antibiotic coverage. after he interventional radiologists placed a drain in the fluid collection that was sent off for culture data. the abscess culture was significant for coagulase negative staphylococcus. infectious disease consultation was placed. recommendations included iv vancomycin. the patient was continued on iv vancomycin and during his stay. the patient was stable after transfer from the intensive care unit. there is no further signs or symptoms of severe sepsis. the patient is being discharged home with a picc line for anticipated 6 weeks of iv vancomycin for chronic osteomyelitis. endocrine: patient has a history of diabetes with insulin dependence. the patient was placed on a sliding scale insulin during his inpatient stay and was monitored closely. hemoglobin a1c was performed which was resulted at 9. the patient has evidence of chronic uncontrolled diabetes. during his stay his blood sugars were monitored and stabilized. the patient will follow up outpatient with his primary care physician for further control of his diabetes. psych: patient had not had indications of suicidal or homicidal ideation. psychiatry consultation was ordered by the medicine service for determination if the patient was competent to leave against medical advice if he so desired. patient was found to competent and has the capacity to leave against medical advice during his stay, although he did not. the patient does have history of polysubstance abuse in the past. the patient was given opiate analgesics postoperatively for pain control. i recommend to the patient he continues to follow up with his chronic pain physician for appropriate control of his opiate analgesic needs. although the hospital stay was quite complicated he was able to be discharged in stable condition with improvement in his anterior chest pain. the patient has a plan is to followup with his primary care physician chronic pain physician as well as the plastic surgeon who performed the patient's surgeries. medications on admission: - gabapentin 800mg - insulin humalog 75-25 mix 100 unit/ml (75-25) 32units qam, 34units qpm - lisinopril 10mg daily - metoprolol succinate 100mg daily - ms contin 30mg - nitroglycerin 0.3mg prn - pioglitazone 30mg daily - ranitidine 150mg - simvastatin 40mg daily - trazodone 50mg qhs - aspirin 81mg daily - cyanocobalamin 500mcg daily - ferrous sulfare 325mg daily discharge medications: 1. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 6 weeks. disp:*84 gram* refills:*0* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 5. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: 0.5 tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 8. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*2* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 12. gabapentin 400 mg capsule sig: one (1) capsule po bid (2 times a day). 13. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours). 14. morphine 30 mg tablet extended release sig: one (1) tablet extended release po q12h (every 12 hours). disp:*60 tablet extended release(s)* refills:*0* 15. hydromorphone 2 mg tablet sig: 2-3 tablets po every hours as needed for pain for 1 weeks. disp:*120 tablet(s)* refills:*0* discharge disposition: home with service facility: physician discharge diagnosis: open wound to the chest, chronic osteomyelitis. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: discharge instructions: personal care: 1. leave your midline chest dressing in place x 48 hours after surgery. you may keep your incision/suture line open to air without a dressing or you may cover your incision with clean, dry dressing daily. 2. clean around the drain site(s), where the tubing exits the skin, with soap and water. 3. strip drain tubing, empty bulb(s), and record output(s) times per day. 4. a written record of the daily output from each drain should be brought to every follow-up appointment. your drains will be removed as soon as possible when the daily output tapers off to an acceptable amount. 5. you may shower daily. no baths until instructed to do so by dr. . . activity: 1. you may resume your regular diet. 2. do not lift anything heavier than 5 pounds or engage in strenuous activity until instructed by dr. . . medications: 1. resume your regular medications unless instructed otherwise and take any new meds as ordered. 2. you may take your prescribed pain medication for moderate to severe pain. you may switch to tylenol or extra strength tylenol for mild pain as directed on the packaging. please note that percocet and vicodin have tylenol as an active ingredient so do not take these meds with additional tylenol. 4. take prescription pain medications for pain not relieved by tylenol. 5. take colace, 100 mg by mouth 2 times per day, while taking the prescription pain medication. you may use a different over-the-counter stool softerner if you wish. 6. do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. . call the office immediately if you have any of the following: 1. signs of infection: fever with chills, increased redness, swelling, warmth or tenderness at the surgical site, or unusual drainage from the incision(s). 2. a large amount of bleeding from the incision(s) or drain(s). 3. fever greater than 101.5 of 4. severe pain not relieved by your medication. . return to the er if: * if you are vomiting and cannot keep in fluids or your medications. * if you have shaking chills, fever greater than 101.5 (f) degrees or 38 (c) degrees, increased redness, swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * any serious change in your symptoms, or any new symptoms that concern you. . drain discharge instructions you are being discharged with drains in place. drain care is a clean procedure. wash your hands thoroughly with soap and warm water before performing drain care. perform drainage care twice a day. try to empty the drain at the same time each day. pull the stopper out of the drainage bottle and empty the drainage fluid into the measuring cup. record the amount of drainage fluid on the record sheet. reestablish drain suction. followup instructions: provider: , md; please call upon discharge to make an appointment to follow up next week. ., , , office phone:( provider: , md phone: date/time: 9:30 the above appointment is with infectious disease which is located on the , , , . . provider: , md phone: date/time: 2:10 the above appointment is with who are located on the , building, . . provider: , md phone: date/time: 1:00 this appointment is with the spine center who is located on the , building, . procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] graft of muscle or fascia aspiration of other soft tissue central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: other chronic pain anemia, unspecified esophageal reflux tobacco use disorder other postoperative infection unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other opiates and related narcotics causing adverse effects in therapeutic use percutaneous transluminal coronary angioplasty status constipation, unspecified other and unspecified hyperlipidemia anxiety state, unspecified loss of weight long-term (current) use of insulin septic shock old myocardial infarction other diseases of lung, not elsewhere classified methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site altered mental status diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled other disorders of plasma protein metabolism chronic pancreatitis other disorders of muscle, ligament, and fascia family history of malignant neoplasm of trachea, bronchus, and lung chronic osteomyelitis, other specified sites other orthopedic aftercare impotence of organic origin combinations of opioid type drug with any other drug dependence, in remission 

Answer: The patient is high likely exposed to