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 / tegretol / spironolactone attending: chief complaint: urinary retention x 1 week fevers x 2 days major surgical or invasive procedure: left septic hip wash out intubation extubation thoracentesis history of present illness: 72 year-old male with diastolic heart failure, avr, af on coumadin, cad, pulmonary hypertension, chb s/p ppm, and severe copd admitted with weight gain, urinary retention, and fever. son at bedside provides majority of history. famiy noted weight up to be up by approximately 5lb yesterday morning (baseline ~148) - discussed with patient's pcp, recommended metolazone 2.5mg iv x1 with lasix. also, difficulty with lasix administration time - receiving 2 doses 5 hours apart rather than every 12 hours over past 1 week. patient with no salt diet, and strict fluid restriction to 1.75 liter per day. . over past day had increasing difficulty with urination. yesterday took attempts at a time before he was able to urinate, and then only small amounts. also with fever to 100.8 this morning. decreased po intake today. patient presented to ed for further evaluation. . of note, inpatient with copd exacerbation and acute on chronic diastolic heart failure. received steroids/antibiotics; lasix 120mg iv bid (continued at discharge). medication changes included adding prednisone taper, azithromycin, and ipratropium. . in the ed, 100.7 63 99/44 16 97% 2l nc. physical examination notable for midline site without erythema; well-appearing male. sons at bedside. laboratory data significant for creatinine 1.9, hematocrit 36.4, wbc 7.9 with left shift, lactate 2.6; ua within normal limits. urine culture, blood culture x2 sent. cxr 2v with with fluid overload, ?rll pneumonia. ekg with v-paced, similar to prior. discussed with cardiology; troponin elevation likely related urinary retention; recommend no intervention at this time. foley placed with 600cc 0> 1l output. received lasix 120mg iv per home regimen, vancomycin iv, and levofloxacin iv. on transfer to medicine service, 102.3, 117/66, 74, 20, 100% 2l. . on the floor, patient able to participate in full review of systems. reports feeling relief after foley placement. he is without night sweats, headache, visual changes, sinus congestion, cough, sore throat, chest pain, palpitations, abdominal pain, nausea, vomiting, dysuria. he has constipation. no skin rashes. past medical history: cads/p 2v cabg htn hld severe diastolic chf (ef >60% ) pulmonary hypertension a fib on coumadin hx of 3rd degree block s/p ppm, currently v-paced hx of as s/p avr with mechanical valve () copd hx of cva c/b seizure do, on lamictal diet-controlled dm chronic kidney injury -chronic lethargy and confusion with concern for dementia -focal disection of abd aorta - noted ct abdomen - unchanged from -bph (no difficulty voiding) -s/p l orif and thr social history: he currently lives with wife and son in a two story home. he is a retired newpaper journalist; he moved to the u.s.a. in , but returned to to work. he returned here permanently in . he does not currently smoke, but quit 10 years ago with an 80 pack year history. family history: there is a family history of cad. all sisters and brothers are deceased. physical exam: admission pe: 99.6, 120/59, 65, 18, 97%3l general: alert; comfortable; at times with pain when moving left leg (he and son report chronic after hip surgery last year) heent: sclera anicteric, dry mucous membranes neck: supple - flexion, extension without difficulty; bounding venous pulsation lungs: crackles to mid-lung fields bilaterally; no wheezes or rhonchi appreciated cv: irregularly irregular; normal s1; pronounced s2; no murmurs appreciated abdomen: hypoactive bowel sounds; soft, nontender, and not distended ext: thin; venous stasis changes; faint lower extremity pulses; no lower extremity edema; no erythema or swelling noted at left hip neuro: no facial droop noted; squeezes both hands equally, reduced (); moves lower extremities skin: no erythema/drainage noted at rue midline site . discharge pe: 98.6, bps ranging from high 70s systolic to 120s with diastolics ranging from 40s-60s, hr=60s, rr=20, pox=100% 3l nc general: confused at times, a+ox1-2 (person and sometimes place) pertinent results: pertinent labs: 02:40am blood wbc-12.7* rbc-2.72* hgb-7.9* hct-24.5* mcv-90 mch-29.0 mchc-32.2 rdw-20.1* plt ct-201 02:40am blood pt-16.8* ptt-40.0* inr(pt)-1.5* 02:40am blood glucose-60* urean-83* creat-2.9* na-138 k-3.5 cl-100 hco3-31 angap-11 02:40am blood calcium-8.2* phos-4.3 mg-2.1 05:59am blood vanco-14.2 . echo: the left atrium is markedly dilated. the right atrium is markedly dilated. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated with depressed free wall contractility. a bileaflet aortic valve prosthesis is present. the transaortic gradient is higher than expected for this type of prosthesis. the mitral valve leaflets are mildly thickened. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . left shoulder and elbow x-ray: clinical information: limited shoulder motion after extubation findings: four total images are obtained including the humerus and elbow. there are mild degenerative changes of the acromioclavicular joint and glenohumeral joint. no fracture is identified in the humerus. within the elbow, there are mild degenerative changes without fracture noted. . cxr: findings: in comparison with the study of , there is again a tiny right apical pneumothorax. the overall appearance of heart and lungs is essentially unchanged. the nasogastric tube has been removed. brief hospital course: medical floor course : #. mrsa bacteremia: mr. was started on vancomycin and cefepime on arrival to the floor . infectious source was considered pna vs. sacral and le ulcers. he was found to have high grade mrsa bacteremia with 6/6 positive blood cultures from the ed (, 19/18, and ). id was consulted and the midline was pulled on hospital day 2 (). daily blood cultures were drawn for evidence of clearing of infection. bacteremia was thought to be due to a transietn bacteremia likely from his sacral stage iv decubitus ulcer or other cutaneous entry point, with the midline serving as a nidus for rapid replication. pneumonia was considered to be another, less likely source of bacteremia. on the evening of cefepime was stopped due to low suspicion for pneumonia and he was started on gentamycin at 0.5mg/kg ( normal dose due to chronic kidney disease) for empiric endocarditis treatment. tee was performed on to look for valvular vegetations and showed no vegetations, and left atrial appendage thrombus could not be ruled out. ct chest was performed to look for evidence of pneumonia. given back and hip pain, plain xray of his hip was performed on admission and showed no obvious fracture, though could not rule out fracture of greater trochanter. ct back and hip were performed to look for evidence of osteomyelitis or spinal cord compression given urinary retention and back pain (though neuro exam showed intact, symmetric reflexes and strength and normal perianal sensation), or florid abnormality of hip prosthesis, as mr. was not a candidate for mri due to pacemaker and not considered candidate for joint aspiration given multiple medical comorbities, fragile skin, and florid bacteremia. vancomycin was continud for the mrsa. . # left hip pain: mr. reported intermittent left hip and leg pain and muscle spasms. plain x-ray on admission negative for fracture though left trochanter could not be evaluated. ct on no obvious fluid collection, unable to evaluate hip given streak. could not get mr due to pacemaker. on he was evaluated by his orthopedic surgeon dr. and his team and it was decided that he should undergo emergent aspiration of his left hip joint due to concern for septic joint. his left hip was aspirated under ir guidance on and showed mrsa. he was taken to the or by orthopedic surgery for prosthetic hip replacement on and tolerated the procedure but was unable to be extubated and was transferred to the icu please see micu course below. . # urinary retention: u/a and urine culture were negative. known bph + retention likely precipitated by ipratropium (new med as of 1 month prior admission) and lasix dosing every 5 instead of hours. continued on home flomax. hold anticholinergics. foley placed ( - ). home lasix; cr and bun bump with diuretics. ctm. . #. decompensated diastolic heart failure: lasix 120mg iv bid goal 500cc to 1l daily, beta-blocker, aspirin, statin . #. cad: s/p 2v cabg. troponin above baseline at admission, trending down, decreased clearance. . #. atrial fibrillation s/p ppm placement for 3rd degree chb: mr. was maintained on coumadin and heparin gtt drip for coumadin. b-blocker held due to sbps in 90s. she was seen by electrophysiology on who interrogated his pacemaker and reset it so that it would have decreased variation with activity, as it had detected his tremors and artificially elevated his heart rate. on the morning after it was reset, creatinine improved to 1.7 from 1.9 despite aggressive diuresis with lasix and an increase in his sodium to a max of 148. tte was performed on to look for preliminary signs of endocarditis while awaiting tee and also to assess for improvement in ef s/p pacemaker adjustment. . #. aortic stenosis s/p avr: inr subtherapeutic on admission. heparin gtt was started with goal ptt 60-100. . # copd: o2 was weaned. o2 sats ranged from 96-100% on room air. holding anticholinergics . micu course : . # respiratory failure: he was intubated for his left septic hip washout and could not be extubated after the surgery for several reasons. the cause was likely bacteremia with ards as well as multifocal pneumonia, diastolic heart failuure (volume overload), and copd. vancomycin was continued, ceftazidime, and metronidazole were added. sputum also grew mutli drug resistant pseudomonas initially susceptible to ceftazidime. he was intermittently able to tolerate pressure support ventilation, but his poor mental status remained a barrier to extubation. later, his daily cxr started to improve, and his mental status cleared. he remained net quite positive for his length of stay in the icu, so aggressive diuresis with a lasix drip was begun to improve his chances for a successful extubation. he was extubated on without difficulty with good o2 sats on 2-3l nc. he was also changed lasix 80mg iv dosing. he completed a 14 day course of the ceftazidime which was then stopped. . # hypotension: while intubated on a lasix gtt, norepinephrine gtt was started to support blood pressure. he continued to require this after extubation while on a lasix gtt, but it was discontinued once the lasix drip was stopped. when the lasix drip was titrated off, he continued to have ample urine output on lasix iv bolus doses despite systolic blood pressures that occasionally fell into the 70s. # prevotella bacteremia: he grew blood cultures positive for prevotella. flagyl was continued for a total 14 day course and then stopped. . #. acute renal failure: baseline creatinine 1.5 to 2.0. bun high. acei held on admission. creatinine slowly climbed to 3.9. renal was consulted and felt that this was likely atn from his previous hypotension. he was started on levophed to increase maps while on lasix gtt. he put out copious amounts of urine and creatinine downtrended on the lasix gtt and continued to trend down after it was stopped. creatinine was down to 2.9 upon discharge and has been improving slowly with diuresis. his vanco levels should be monitored frequently given his improving renal function and his vanco should be dosed to keep his levels between 15-20. . #. aortic stenosis s/p avr: inr subtherapeutic on admission. heparin gtt was started with goal ptt 60-100. later, he was bleeding slightly into his lung and into his gi tract, and his ptt goal was adjusted to 40-60. when he stabilized, coumadin was restarted at a lower dose with a goal inr 1.8-2.2. his goal ptts on his heparin drip should remain in the 50-70 range until his inr becomes therapeutic. . # copd: he was given a steroid course for the copd component of his respiratory failure. these were tapered and stopped. upon discharge, his home inhaled steroids were restarted. . # goals of care: after extensive discussions, mr. family decided that he would be dnr but ok to re-intubate. medications on admission: metolazone 2.5mg iv prn - last dose yesterday morning aspirin 81mg po daily dorzolamide 2% one (1) drop ophthalmic (2 times a day) fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day) furosemide sig: 120 mg intravenous twice a day. lamotrigine 100 mg tablet sig: 1.5 tablets po bid (2 times a day). potassium chloride 20 meq packet sig: two (2) po twice a day. sildenafil 20 mg tablet sig: two (2) tablet po tid (3 times a day). warfarin 2 mg tablet sig: one (1) tablet po once daily at 4pm: please alternate with 3 mg (dosing varies with inr). guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (). tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). multivitamin oral ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 2 puffs inhalation four times a day as needed for shortness of breath or wheezing - has not used over past 24 hours travatan z 0.004 % drops sig: one (1) drop ophthalmic at bedtime: into each eye. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). simvastatin 20 mg tablet sig: one (1) tablet po once a day. docusate sodium 100 mg capsule sig: one (1) capsule po bid senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 5. sildenafil 20 mg tablet sig: two (2) tablet po tid (3 times a day). 6. lamotrigine 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day). 9. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) g po daily (daily) as needed for constipation. 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze. 13. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 14. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 15. quetiapine 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia, agitation. 16. furosemide 80 mg iv bid 17. heparin drip please continue at 800 units per hour and adjust for goal ptt 50-70 18. insulin please use attached humalog sliding scale. 19. labs please do cbc with differential and basic metabolic panel faxed to on , two days prior to his infectious disease appointment. 20. vancomycin 500 mg recon soln sig: five hundred (500) mg intravenous every other day: please adjust dosing for goal level 15-20. this will continue at least until he follows up with infectious disease clinic on . 21. flovent hfa 220 mcg/actuation aerosol sig: one (1) inhalation twice a day. 22. vitamin d-3 400 unit tablet sig: two (2) tablet po once a day. 23. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 24. multivitamin tablet sig: one (1) tablet po once a day. 25. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation four times a day as needed for shortness of breath or wheezing. 26. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po twice a day. 27. simvastatin 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: mrsa and prevotella bacteremia, pseudomonas pneumonia, mrsa prosthetic joint infection s/p surgical washout, copd exacerbation, diastolic chf . secondary: atrial fibrillation, pulmonary hypertension, cad s/p cabg, type ii diabetes mellitus, chronic kidney injury discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to the hospital because of an infection in your hip and your blood. you were treated with antibiotics and required a surgery to wash out the infection from your prosthetic hip. after the surgery, you were unable to be extubated for a prolonged period of time until your lung status was optimized from an infection, fluid, and copd perspective. your kidneys also suffered injury due to your infections which continues to improve slowly. followup instructions: please follow up with all of your outpatient medical appointments listed below: . 1) cardiology: dr. phone: date/time: 2:30 . 2) infectious disease: dr phone( - medical building basement. at 3:10 pm. please do cbc with differential and basic metabolic panel faxed to two days prior to this appointment. . 3) orthopedics - ortho xray (scc 2) phone: date/time: 12:40. then follow up with provider: , : date/time: 1:00 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances thoracentesis closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus arthrotomy for removal of prosthesis without replacement, hip arthrocentesis insertion or replacement of (cement) spacer central venous catheter placement with guidance diagnoses: acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified severe sepsis obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure aortocoronary bypass status other chronic pulmonary heart diseases chronic kidney disease, unspecified constipation, unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) heart valve replaced by other means pneumonia due to pseudomonas retention of urine, unspecified pressure ulcer, lower back carrier or suspected carrier of methicillin resistant staphylococcus aureus surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled metabolic encephalopathy pressure ulcer, heel other and unspecified infection due to central venous catheter fitting and adjustment of cardiac pacemaker pressure ulcer, stage iv hip joint replacement methicillin resistant staphylococcus aureus septicemia dissection of aorta, abdominal foreign body in larynx pressure ulcer, unspecified stage inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation infection and inflammatory reaction due to internal joint prosthesis 

Answer: The patient is high likely exposed to