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: penicillins attending: chief complaint: hypotension/sepsis major surgical or invasive procedure: no major surgical or invasive procedures. history of present illness: yo m resident of rehab, h/o dementia, dm, with recent admission to last month for fever, likely pna. patient's condition improved with levofloxacin at that time. patient returns today with fever to 102, confusion, hypotension (70/p --> 102/48) with ivf. patient reportedly was not opening eyes. of note, patient has stage 3 decubitus ulcer on ankle. was given po vanco for foot infection and recently started on clindamycin on for foot. also ? has had more frequent stools recently. . in ed, patient was fluid resuscitated and then started on pressors through a peripheral iv. transfused 1 unit blood for hct 25. given vanco, levo, flagyl, dexamethasone. . in the micu, vitals were temp: 97.3 bp: 86/31 on levophed 0.02 p 69 16 98% 4l nc, pan cultures were obtained , with urine cx showing no growth, blood cx pending x2, and stool assay positive for c.diff. empiric coverage was continued with vanco (renal dosing), levo 250 q48, and flaygl 500mg . ivf were given to maintain a map of >60, uop>30cc/hour. her creatinine at admission was noted to be 2.6, baseline of 1.3-1.6. it was thought this was secondary to prerenal azotemia. her creatinine responded well to hydration. her uop has been from 30-100cc per hour. to maintain bp, pt was on levophed, however, this was discontinued 4pm. . for the stage iii decubitus ulcer, surgery was consulted on . she is a familiar pt to them, and her son and daughter had expressed that she did not want any intervention done on her leg (angio or amputation). the daughter stated that she wanted comfort measures only. vacular subsequently signed off. podiatry also saw the pt, and noted that she will likely need bka. as pt's family refusing operation, vanco and the wet to dry dressings were continued. . as pt's family is requesting primarily measures for comfort, (son is , the pt was called out of the micu. family is requesting ivf for bp only, no pressors. they would like antibiotics given, as well as morphine for pain. they are refusing central line, surgery, angioplasty vs. amputation for his leg. they want him to be as comfortable as possible. past medical history: dementia depression dm htn ? cad hypercholesterolemia social history: originally from , immigrated 18 years ago. worked in construction. . no etoh, +tobacco in the past, but none in many years, no recreational drugs. family history: n/c physical exam: 97.3 86/31 on levophed 0.02 p 69 16 98% 4l nc gen: somnolent, arousable and moaning with stimulation heent: pupils pinpoint, dry mm, mouth breathing, jvp 10 cm cv: irreg, s1, s2, 2/6 systolic murmur at rusb lungs: mild crackles at bases, l > r abd: soft, mildly distended, ? moderately tender to palpation ext: warm, 2+ pitting edema bilaterally, l heel stage 3 ulcer, toes with areas of necrosis neuro: minimally responsive, moving all extremities pertinent results: 11:40pm urine color-ltamb appear-clear sp -1.019 11:40pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-6.5 leuk-neg 11:40pm urine rbc-* wbc-0-2 bacteria-rare yeast-none epi-<1 08:05pm lactate-3.5* 07:30pm glucose-74 urea n-54* creat-2.6*# sodium-136 potassium-4.9 chloride-105 total co2-18* anion gap-18 07:30pm wbc-17.6*# rbc-2.69*# hgb-8.5*# hct-25.0*# mcv-93 07:30pm neuts-92* bands-0 lymphs-6* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-1* 07:30pm plt smr-normal plt count-339#ekg: wavy baseline due to patient movement, af @ 90, rbbb, twi ii. 05:02am blood cortsol-33.3* 05:10am blood vanco-22.0* 07:40pm blood vanco-6.9* 04:00am blood vanco-9.2* 10:03am blood type- po2-34* pco2-28* ph-7.29* calhco3-14* base xs--12 08:05pm blood lactate-3.5* . cxr: left lung base opacity, likely representing atelectasis, unchanged since . urine culture (final ): no growth. ekg from ed: nsr@ 80, nl axis, ? 1st degree block renal ultrasound scan (portable) clinical details: dementia, rule out obstructive hydronephrosis. conclusion: limited exam but no evidence of hydronephrosis. bedside swallow eval: there were no signs of aspiration on his bedside swallowing evaluation today, i.e., no cough, no throat clear and no change in voice quality after eating or drinking. pt. denied food sticking in his throat or liquids going down the wrong way. due to extreme oral cavity dryness, the cracker was not given, but i think he would do fine with very soft, moist solids and ground meat. however, he has pain on swallowing and does not want to eat. this may be due to dryness or thrush. brief hospital course: a/p: yo m with dementia, dm who presents with septic shock, s/p 2 days in micu, stabilized on iv antibiotics. family requesting no aggressive interventions. pt on ivf, abx, being transferred to floor for supportive care. **** he is now a complete . no agressive measures. no central line, no peripheral iv, no picc, no fingersticks, no heparin. documented in chart, per family meeting with his son , on friday, . 1. clostridium difficle colitis: pt has been tx with iv flagyl since then switched to po flagyl on after demonstrating tolerating po by swallow evaluation. - rectal tube was removed by rn secondary to pt agitation from tube. however, with continued diarrhea, as his bicarb is low. we performed an abg, however, since he was a difficult person to obtain blood on, we obtained venous blood. we had a family meeting, and clarified with health care proxy, that he did not want any more needlesticks (no insulin, no heparin, no abg), so we honor his wishes. - we held off on sodium bicarb. - he placed on contact precautions. - has remained afebrile. - pt passed his swallow study, did well. started him on pureed, thin liquid diet. . # initial presentation of sepsis: given presentation of fever, tachycardia, persistent hypotension, patient met definition of septic shock at admission. source not entirely clear but could be related to le ulcer, or c. diff colitis. cxr with no pna; patient with no evidence of uti. -abx: /levo/flagyl () d/c vanco on (lost iv access, had family meeting, agreed to d/c vanco) - continue broad spectrum abx po (levo, flagyl) renally dosed. - patient has reported h/o mrsa in le wound, tx with iv vanco . d/c'd as pt is and family requesting d/c all ivs. - per ed, patient's family declined invasive interventions including central line. pt is off pressors, and s/p ivf for pressure maintenance. no ivf now as status per family request. . 2. stage 3 decubitus ulcer - family refusing angio or amputation. signed off (as per hpi). podiatry saw pt, thought may need possible bka, however, family refusing, do not want aggressive measures/intervention undertaken. -wet--> dry dressings - vanco d/c'd on as per above. . 3. anemia: patient has h/o anemia (fe-def/acd) and required 2 unit transfusion during previous admission. -guaiac negative per ed report - no transfusions () . #agitation - we had to restrain with 2 point restraints on upper extremities b/c he was pulling at his lines. - we started zydis orally for agitation in preparation for d/c to rehab. he tolerated this well. - he self d/c'd his foley on . replaced his foley on . uop has been decreased, dark amber in color. pt encouraged to take po liquids. no iv, as pt and family refusing needlesticks, fingersticks, iv. . 4.dm2: - d/c ssi d/c fingersticks . 5. arf: baseline creat 1.3- 1.6. ? on admission, creatinine 2.6, most likely prerenal azotemia, responded well to ivf, with creatinine trending down. - last cr, 1.4 (trended down from 1.9) so pt is improving with hydration and feeds. - fena on admission was <1% in favor of prerenal - continue feeds with pureed liquids. . 6. ?af vs ectopy: no known history of af. no clear p waves on ekg from icu. ? ectopy related to pressors. rate well controlled. ? candidate for anti-coagulation. - pt is rate-controlled, and we will not intervene with medical intervention now. . 7. htn: we held his antihypertensive medication as his blood pressure was low in micu, he is now normotensive. . 8. hypercholesterolemia: - his statin was discontinued secondary to elevated ck's. . 9. ppx: - sc heparin - ppi. . 10. code: dnr/dni, now , to rehab on sunday, with referral for hospice care. medications on admission: aspirin 81 mg qd ferrous gluconate 300 mg qd brinzolamide 1 % drops enalapril maleate 5 mg tablet qd simvastatin 20 mg tablet qd senna 8.6 mg tablet tylenol #3 clindamycin 300 qid glipizide 10 qd metformin 500 vancomycin po discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 3. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). disp:*30 tablet, rapid dissolve(s)* refills:*2* 4. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 5 days. disp:*15 tablet(s)* refills:*0* 5. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 6. morphine 10 mg/5 ml solution sig: one (1) po q2-4h (every 2 to 4 hours) as needed for pain. disp:*qs 1 bottle * refills:*0* discharge disposition: extended care facility: for the aged - discharge diagnosis: 1. sepsis 2. clostridium difficile colitis 3. stage iii decubitus ulcer left heel 4. diabetes mellitus 5. dementia 6. hypercholesterolemia discharge condition: stable discharge instructions: please take all of your medications as directed. please follow up with your physician, . . please see instructions below. followup instructions: 1. please follow up with your primary care physicians at rehab. 2. provider: where: date/time: 11:30 3. provider: , surgery where: surgery date/time: 12:00 procedure: transfusion of packed cells diagnoses: anemia, unspecified pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis other persistent mental disorders due to conditions classified elsewhere septic shock intestinal infection due to clostridium difficile pressure ulcer, heel 

Answer: The patient is high likely exposed to