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: nafcillin attending: chief complaint: knee pain, drainage major surgical or invasive procedure: left knee total knee replacement resection with antibiotic spacer, left knee irrigation and debridement paracentesis, endotracheal intubation, mechanical ventilation, bronchoscopy, bronchoalveolar lavage history of present illness: 54yo male referred in to ed from for evaluation of reported increase in pain and drainage from knee surgical incision site. patient reports surgical incision staples were removed late last week and he noticed fluid dripping down his leg intermittently since , while ambulating with physical therapy. he states no increase in pain during this time. patient reports increase in activity with physical therapy on , leading to some increased diffuse knee pain that completely resolved at rest. he denies any recent fevers, chills, or diaphoresis. he notes development of significant knee swelling which is similar to in the past. his recent medical course is notable for septic left tka and left shoulder s/p i&d on and . past medical history: - alcoholic cirrhosis - gib , found to have gastric ulcers on egd, no varices - etoh abuse - left rotator cuff tear social history: etoh abuse for many years, 8-10 beers per day, refers he quit 3 wks ago. no illicits drugs. previous smoker, quit a couple of yrs ago. lives in with his wife. is retired prision officer. family history: diabetes-father physical exam: admission exam: vs: 96.0 122 134/77 27 99% on 15% fm general: awake, oriented to person, hospital setting, year but not month, uncomfortable appearing in mild respiratory distress heent: perrl, eomi, sclera anicteric, mmm, oropharynx clear neck: supple, no lad, jvp difficult to assess given accessory muscle use lungs: bibasilar rales with rhonchi in upper air fields, no wheezing, labored breathing with accessory muscle use cv: tachycardic but regular, normal s1 s2, no r/m/g appreciated abdomen: hypoactive bowel sounds, moderately distended, tympanitic, mildly tender to palpation, no rebound tenderness or guarding gu: foley draining dark yellow urine ext: 2+ dp/pt on rle, faint dp/pt , 3+ edema bilaterally to knees, left knee with dressing and brace in place c/d/i neuro: awake, oriented to person, hospital setting, and year only, +asterixis, perrl, moving all four extremities pertinent results: admission labs: 10:45pm blood wbc-8.1 rbc-2.58* hgb-8.7* hct-25.2* mcv-98 mch-33.6* mchc-34.4 rdw-16.8* plt ct-266 10:45pm blood neuts-76.8* lymphs-15.1* monos-5.3 eos-2.3 baso-0.5 10:45pm blood pt-17.1* ptt-33.8 inr(pt)-1.5* 10:45pm blood glucose-104* urean-18 creat-1.0 na-130* k-3.6 cl-97 hco3-25 angap-12 04:47am blood alt-5 ast-30 alkphos-92 totbili-1.2 04:47am blood albumin-1.9* calcium-7.9* phos-3.5 mg-1.5* 11:01pm blood lactate-1.3 . microbiology: sputum culture: --gram stain: no microorganisms --culture: sparse yeast; commensal flora peritoneal fluid: 90 wbc, 105 rbc, 62 pmn, 22l, 16m, total protein 1, glucose 185, ldh 51, albumin 0.5 --culture: negative urine culture: yeast blood culture: negative peritoneal fluid culture: --gram stain: 1+ polys, no microorganisms --fluid culture: no growth --anaerobic culture: no growth blood cultures x2: pending urine culture: yeast urine culture: yeast stool: negative for c. diff sputum: --gram stain: no microorganisms --fungal culture (prelim): yeast --legionella culture (prelim): no legionella isolated --no pcp culture: rare growth yeast mycolytic blood culture: pending sputum: --gram stain: no microorganisms --respiratory culture: sparse growth yeast sputum: --gram stain: no microorganisms --respiratory culture: sparse growth yeast left knee joint fluid: --no microorganisms blood culture: negative blood culture: negative peritoneal fluid: negative . imaging: knee xray: no radiographic evidence of osteomyelitis. status post total knee arthroplasty without evidence of hardware failure. . u/s: no left lower extremity dvt. . knee xray: the left knee arthroplasty has been removed and there is a methyl methacrylate spacer in the knee joint. smooth periosteal reaction about the distal shaft of the femur is unchanged and likely reactive to the recent infection. hpoa could have a similar appearance and note is made of the recent chest radiograph dated . expected post surgical changes including soft tissue swelling as well as a surgical drain are noted. . cta chest: 1. mild multifocal pneumonia. 2. no pulmonary emboli. possible pulmonary hypertension. 3. mild dependent atelectasis. small bilateral pleural effusions. 4. severe ascites. 5. atherosclerotic coronary calcification, right, left, and left anterior descending segments. . bilataral le u/s: complete thrombosis of the left anterior gastrocnemius vein (communicating vein/perforator vein) of the left calf. . ct chest w/o con: newly occurred massive consolidations and opacities, predominating in the upper lobes but also visualized in the peribronchial areas of the middle lobe and both lower lobes. the changes are suspicious of non-recent pneumonia, combined to atelectasis, which has already been suspected on previous chest films. newly appeared moderate right pleural effusion, increased left pleural effusion. numerous mucus accumulations in the tracheobronchial tree. mild decrease in extent of the pre-existing ascites. . ct abdomen/pelvis: 1. extensive ascites with mesenteric edema and anasarca, findings consistent with decompensated cirrhosis. no discrete loculated fluid collection to suggest abscess, though evaluation is limited due to the free fluid and non-contrast technique. 2. multifocal consolidations within the lung bases consistent with pneumonia. bilateral pleural effusions, left greater than right. 3. stable appearance of the ivc filter, post-pyloric ng tube, rectal tube, and foley catheter. 4. no definite evidence of colitis, though evaluation is limited due to extensive free fluid and non-contrast technique. . ct head w/o con: moderately motion limited study without evidence of an acute intracranial process. . bilateral ue u/s: occlusion of the distal segment of the right radial artery, without evidence of flow. brief hospital course: 54 year old man with etoh cirrhosis, recent mssa bacteremia with left septic prosthetic knee and left septic shoulder, initially admitted to the ortho service with increased drainage from the left knee, s/p l tka resection, with course complicated by development of hypoxemic respiratory distress requiring transfer to the micu. . # goals of care: after discussions between the micu team and the patient's wife and family members, the decision was made to focus on comfort measures. the patient was extubated and pain was controlled with morphine. he passed several hours later. . # hypoxemic respiratory distress: on , patient became hypoxic with sat of 90% on 6l nc. cta negative for pe, but showed multifocal pna. was concern patient may have aspirated in setting of ams hepatic encephalopathy, and also concern for volume overload in setting of multiple recent transfusions given elevated jvp. patient briefly improved following administration of lasix, though given continued decline in respiratory status patient transferred to micu for further monitoring. started on broad spectrum antibiotics with vanc/cefepime given concern for hcap. was already on cipro for l knee infection, with id following, though id felt cipro could be stopped given broader coverage with vanc/cefepime. restrictive physiology from worsening ascites and abdominal distension was also felt to be contributing, though diuresis initially limited secondary to . once renal function initially improved, patient started back on lasix, was weaned to 2l nc, and underwent paracentesis with removal of 3l peritoneal fluid on . patient was electively intubated for return to or on and remained intubated post-operatively. abx changed to vanc/meropenem on per id recs given persistent/worsening leukocytosis. had repeat ct chest, which showed worsening of multifocal pna with bilateral patchy consolidations. antibiotic course continued through , for total of 13 day course of treatment for presumed hcap. was also thought that pna may have been chemical insult from aspiration, as patient did not significantly improve on broad spectrum abx. sputum cultures sent, but only positive for rare yeast, and all blood cultures remained negative. ongoing respiratory distress again thought to be multifactorial from pna, restriction from significant ascites, and volume overload in setting of repeated transfusions and worsening renal function with near anuria. as below, patient started on crrt on , and chest imaging did show improvement in bilateral pulmonary congestion. patient's vent settings were changed from assist control to pressure support, and patient did well, though extubation was limited by patient's mental status. patient also had repeated paracenteses, with 2-3l fluid removed each time as below. . # altered mental status: patient initially with ams secondary to hepatic encephalopathy prior to icu transfer, in setting of refusing . had some improvement in ms dosing increased, though developed increasing confusion in icu most likely secondary to delirium in setting of post-op pain and infection. patient was intubated on for return to or, and given initial sedation with propofol, and later with fent/midaz, was difficult to fully assess mental status. however, patient weaned off all sedation, but remained unresponsive to voice and was not following commands. was though to have persistent encephalopathy, and also ams secondary to uremia in setting of worsening renal function. ct head was negative for acute intracranial process. . # hypotension: patient was on phenylephrine following intubation on , though this was weaned off within several days with stabilization of bp. hypotension felt to be multifactorial in setting of underlying cirrhosis, acute blood loss peri-operatively, infection, and sedation. patient had recurrent hypotension when starting on hd; was switched to crrt and had arterial line placed for closer monitoring on . also received small fluid boluses as needed for recurrent hypotension. . # : at time of transfer to icu, cr noted to have trended up from 1.0 to 1.7. patient had h/o recent ain from nafcillin, and urinalysis still revealed rare eosinophils. however, was more concern for pre-renal azotemia/transient ischemia causing acute worsening of renal function. renal consulted, and felt presentation most c/w ischemic injury based on presence of granular casts and sheets of hyaline casts in urine. was some concern for hrs, given low urine na, though patient was responsive to albumin challenge and maintained good urine output initially. however, again developed worsening renal function with significant rise in cr, and renal re-consulted on and felt secondary to ischemic atn. urine output continued to decline, and patient became nearly anuric with ~100cc urine output daily. decreased urine output was also exacerbated by increased bladder pressures, noted to be as high as 28 in setting of worsening ascites and abdominal distension on . had repeat para with 3l removed, and resultant decrease in bladder pressure to 12. went to ir for placement of temp hd line on , and was started on hd later that day with about 500cc volume removed. given hypotension occurring during hd, but desire to remove volume given persistent respiratory distress, patient started on crrt on to allow removal of greater volume. goal was for removal of 100-200cc/hr if bp would tolerate, and arterial line placed for closer bp monitoring. hd line clogged on , though became patent again after administration of tpa. crrt was discontinued on when the patient was transitioned to cmo. . # left knee drainage: initially admitted to ortho service. was on daptomycin and cefazolin, which had been started for mssa bacteremia and vre bacteremia during previous admission. dapto course completed , cefazolin was continued initially. patient taken to or and all hardware was removed on . the surgery was c/b ebl ~4l and he was given 6 units prbc, 4 units ffp, 3 units albumin, 1 unit platelets, and 2 units cryoprecipitate intra-operatively. on the floor, he received another 3 u prbc. joint fluid culture did grow pseudomonas, and patient started on cipro. all other cultures remained negative, and cipro later d/c'd as this was felt to be contaminant and not true infection by id consulting team. patient's jp drain removed while patient in icu, though patient continued to have oozing from left knee given underlying coagulopathy from his liver disease. patient transfused additional 2 units prbcs in icu, and also given vitamin k given elevated inr. oozing from surgical site slowed. patient's knee kept immobilized. given concern about developing fluid pocket in right knee, with rise in patient's wbc, patient taken back to or on for i&d of left knee via arthrotomy, removal of antibiotic spacer and insertion of new spacer. patient electively intubated for procedure, and remained intubated post-op. had about 1.5l blood loss during operation, requiring additional transfusions of prbcs and ffp. fluid pocket felt to be hematoma and not infection, and cultures sent from or negative. patient continued on antibiotics throughout his hospital course (see below), though when antibiotic course for multifocal pna completed on , patient switched back to cefazolin for planned 6 week course of treatment of l septic knee, scheduled to end . . # etoh cirrhosis: patient with decompensated cirrhosis this admission. increased ascites noted intraoperatively on . patient initially continued on home regimen of spironolactone and lasix, as well as , though spironolactone and lasix later stopped in setting of worsening renal function. had therapeutic thoracentesis on during which 2 l of fluid were removed, chemistries were unremarkable. was increased to 45 mg qid because patient was not having bowel movements and was felt to be developing hepatic encephalopathy. patient followed by liver service. had repeat paracentesis with removal of 3l fluid, and another paracentesis on which was also negative for sbp. started on rifaximin. dobhoff placed in or on for increased nutritional support, and patient continued on thiamine and folate. had additional paracentesis on (3l fluid removed each time). the patient was not a transplant candidate. . # dvt: patient found to have dvt in left gastrocnemius via lenis performed . started on heparin gtt, though drip stopped prior to patient's return to or on for i&d of left knee and replacement of antibiotic spacer. given surgery and concern for ongoing blood loss post-operatively, patient could not be anticoagulated and therefore had ivc filter placed. he was continued on prophylactic heparin. . # right radial artery thrombus: patient found to have clot in r radial artery on ultrasound. right ulnar artery was patent. patient did not have any arterial cannulation or abgs obtained from right side. . # diarrhea: patient noted to have increased stool output on , and which was felt to be multifactorial from increased dosing and antibiotic course. was concern for c. diff given hospital course and antibiotic administration, and patient was started empirically on iv flagyl. several stool samples negative for c. diff, and flagyl eventually stopped after c. diff pcr came back negative. . # uti: patient noted to have yeast persistently in urine, and completed a 7-day course of fluconazole. foley replaced, and eventually removed as patient anuric. medications on admission: lasix 40mg po daily spironolactone 100mg daily 30ml po qid cefazolin 2g q8 daptomycin 600mg q24 pantoprazole 40mg po q12h enoxaparin 40mg daily until thiamine 100mg daily folic acid 1 tab daily multivitamin daily docusate senna prn miralax prn tylenol prn discharge disposition: expired discharge diagnosis: during the patient's icu stay, the patient was transitioned to comfort-focused care based on extensive discussion with the family/hcp. the patient died overnight after transfer out of the icu, with family at the bedside. discharge condition: deceased procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization local excision of lesion or tissue of bone, tibia and fibula arthrotomy for removal of prosthesis without replacement, knee insertion or replacement of (cement) spacer insertion or replacement of (cement) spacer diagnoses: acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver hyposmolality and/or hyponatremia methicillin susceptible staphylococcus aureus septicemia sepsis other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus accidents occurring in other specified places other ascites gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diarrhea encounter for palliative care do not resuscitate status encephalopathy, unspecified knee joint replacement other and unspecified alcohol dependence, unspecified acute venous embolism and thrombosis of deep vessels of distal lower extremity other accidents pyogenic arthritis, shoulder region infection and inflammatory reaction due to internal joint prosthesis 

Answer: The patient is high likely exposed to