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: clotrimazole / augmentin attending: chief complaint: fevers, low blood pressure, abdominal pain major surgical or invasive procedure: ct guided drainage of peri-hepatic abscess with placement of a pig-tail drain. ercp with placement of cbd stent ultrasound guided picc placement history of present illness: 65m with chronic pancreatitis, several intra-abdominal abscesses p/w with 3 d of severe low back pain. patient has been to ed 3 times in the past 3 days with no resolution of symptoms. he reports that he can not move or walk due to the pain, worst with standing up, no radiation. he spoke with his pcp today, who was concerned about osteomyelitis given low back pain with history of intraabdominal abscesses and elevated white count. he recommended he come to the ed for evaluation. . in the ed, initial vs were: 98.1 79 100/64 20. physical exam showed tenderness to palpation adjacent to spine. labs were remarkable for elevated alk phos and wbc 14.2. he was given hydromorphone 2mg po q8h for pain control and started on iv vancomycin and ceftriaxone, no blood cultures were drawn prior. no imaging obtained in the ed. admitted to medicine for evaluation of osteomyelitis. vitals prior to transfer were 98.4 87 116/83 16 95% room air. . on arrival to the floor, the patient was found to be hypotensive to the 70s sytolic, tachycardic to the 130s, febrile to 102. he was given 3l ns, blood cultures were drawn. labs were redrawn and wbc had risen to 25.5 (from 14.2 6h earlier), lactate 4.0. given daptomycin to cover vre, given his hx of vre bacteremia in the past. he was transfered to the micu for sepsis. . on arrival to the micu, he is lying in bed complaining of pain in his back but otherwise doing well. awake and interactive, able to give the hpi. past medical history: 1. multiple polymicrobial fluid collections, status post multiple drain procedures over the past several years. most recently mrsa in new l flank abscess in , past h/o psoas abscess, retroperitoneal abscess, enterocutaneous fistula. 2. ventral hernia repair complicated by severe pancreatitis, leading to a nearly yearlong hospitalization starting at and at the to rehabilitation ending . 3. pancreatic mass per gi notes. endoscopic ultrasound performed twice, most recently showing 2 x 3 cm ill-defined mass to the pancreas. fna was performed. no malignancy was found. 4. cad status post mi 5. diverticulosis. 6. anxiety. 7. hypothyroidism. 8. hypertension. 9. lower extremity dvt status post ivc filter ( or ) 10. portal vein thrombosis. 11. status post fundoplication 16 plus years ago complicated by splenic injury requiring splenectomy. 12. bph. 13. vitamin d deficiency. 14. abnormal lfts intermittently, most recently thought due to augmentin. 15. gynecomastia. 16. cirrhosis - dx in social history: lives in with his wife. is unemployed. - tobacco: smoked <1 ppd for 1 year in the past - alcohol: denies - illicits: denies family history: non-contributory. physical exam: on admission: vitals: t: 96.7 bp: 97/66 p: 99 r: 18 o2: 98% on 3l general: alert, oriented to place and situation but not time. in no acute distress unless being turned/moved (severe pain) heent: perrl, sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: diminished breath sounds in bases bilaterally, no wheezes, rales, ronchi abdomen: bs+, distended, caput medusa seen, soft, moderately tender to palpation of ruq and left flank. protrusion seen below ribs on right side. some voluntary guarding, but no rebound gu: foley draining clear yellow urine back: pain to palpation of spine at l3-l5 levels, no paraspinous tenderness ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cns ii- intact, strength 4+/5 and symmetric in ue, stength in hip flexors and knee extensors, in other le muscle groups. discharge: vs: 98.7, 116/80, 85, 16, 97% ra. gen: resting comfortably in bed; appropriate conversation heent: perrla, eomi lungs: cta bilat, no r/rh/wh cvs: rrr, no mrg, nl s1/s2 abd: nontender to palpation in all four quadrants and flank. mildly distended, bs x 4, no masses, dilated superficial epigastric veins; ruq drain w/ scant green bilious fluid ext: warm, perfused, 2+ edema b/l; picc in place skin: no rashes neuro: cniii-xii intact, strength 5/5 throughout, sensation grossly intact b/l ue/le, gait not tested. . pertinent results: 07:00pm blood wbc-16.1* rbc-4.23* hgb-12.0* hct-36.6* mcv-87 mch-28.5 mchc-32.9 rdw-15.2 plt ct-765* 07:00pm blood neuts-85.6* lymphs-6.5* monos-5.8 eos-1.1 baso-0.8 07:00pm blood pt-14.2* ptt-27.2 inr(pt)-1.2* 06:45pm blood esr-56* 07:00pm blood glucose-74 urean-12 creat-0.6 na-138 k-4.9 cl-105 hco3-25 angap-13 06:45pm blood alt-19 ast-38 alkphos-304* totbili-0.3 06:45pm blood lipase-31 06:45pm blood albumin-2.1* 06:45pm blood crp-188.3* 02:26am blood lactate-4.0* calhco3-19* . 07:25am blood wbc-9.9 rbc-3.36* hgb-10.2* hct-31.0* mcv-92 mch-30.4 mchc-33.0 rdw-18.1* plt ct-596* 10:00am blood neuts-73* bands-0 lymphs-16* monos-7 eos-3 baso-1 atyps-0 metas-0 myelos-0 07:25am blood glucose-78 urean-37* creat-3.4* na-141 k-4.4 cl-110* hco3-22 angap-13 09:30am blood alt-11 ast-37 ld(ldh)-165 alkphos-219* totbili-0.4 09:00am blood ck(cpk)-18* 04:05am blood lipase-20 09:00am blood ck-mb-2 ctropnt-0.03* 07:25am blood calcium-8.3* phos-4.6* mg-1.9 06:10am blood cea-1.4 afp-2.7 . ct abdomen: 1. a longstanding fluid collection adjacent to the right hepatic lobe and the gallbladder persists, and shows mild increase in size since . this most likely represents a pseudocyst, though abscess or superinfection cannot be excluded. note is made of an equivocal communication to the gallbladder/cystic duct. this could be further assessed with hida on a nonurgent basis. 2. no additional sites of new or worsening fluid collections. 3. unchanged appearance to intra- and extra-hepatic biliary ductal dilatation, foci of free air adjacent to the liver and pancreatic head, extensive inflammatory and fibrotic change in the region of pancreatic head along with cavernous circulation transformation of the portal vein, all consistent with changes of prior/chronic pancreatitis. . mr : technique: sagittal t1, t2 stir and axial t1- and t2-weighted images were obtained through the lumbar spine. following administration of intravenous contrast, sagittal and axial t1-weighted images were obtained. . findings: lumbar vertebrae reveal normal height and signal intensities. there is grade 1 retrolisthesis at l5-s1. the spinal cord terminates at the upper border of l1. conus medullaris and cauda equina has normal morphology and signal intensities. . at t12-l1, l1-l2, there is no significant disc herniation, spinal canal or neural foraminal narrowing. . at l2-l3, there is mild disc bulge with no significant canal or neural foraminal narrowing. . at l3-l4, there is disc desiccation with diffuse disc bulge, but no significant canal or neural foraminal narrowing. . at l4-l5 there is disc desiccation with diffuse disc bulge and posterior annular tear causing mild narrowing of bilateral neural foramina but no significant nerve root impingement is seen. . at l5-s1 there is grade 1 retrolisthesis with type 2 endplate changes. there is a posterior disc protrusion predominantly to the left of the midline touching the traversing left s1 nerve root. . post-contrast scans reveal no abnormal enhancement. subtle signal alteration in bilateral psoas muscles, likely secondary to inflammatory changes in the retroperitoneum. there is no evidence of epidural abscess. . impression: 1. degenerative changes in the lumbar spine, most prominent at l5-s1 where there is grade 1 retrolisthesis with discogenic endplate marrow changes. no evidence of epidural abscess. . 2. subtle signal alteration in bilateral psoas muscles, likely secondary to inflammatory changes in the retroperitoneum. no drainable collection is seen. . mrcp: mr abdomen with mrcp . clinical history: a 65-year-old man with history of chronic pancreatitis and several intraabdominal masses, presents with sepsis. evaluation prior to ercp. . technique: multiplanar t1 and t2-weighted images of the abdomen were obtained both pre- and post-administration of 15 cc of gadolinium dtpa. the patient was also given 75 cc of distilled water mixed with 5 cc of gadolinium orally. . a prior ct study of the abdomen and pelvis dated was available for comparison. . findings: . lung bases: lung bases are included and show a small left-sided pleural effusion which is new in comparison with the prior study. . abdomen: the patient is status post splenectomy. few splenosis nodules are identified in the splenic bed. the liver is normal in size. no focal hepatic lesions are identified. there is persistent moderate dilation of the intra- and extrahepatic biliary system with tapering of the common bile duct at the level of the head of the pancreas. there is also stable persistent dilation of the main pancreatic ducts also tapering within the head of the pancreas. there is stable-appearing inflammation in the head of the pancreas and the duodenal sweep consistent with the patient's known diagnosis of chronic pancreatitis. an air-fluid level is identified in the cystic duct stump. there is also stable mild right-sided hydronephrosis, most likely due to the presence of inflammation adjacent to the right renal pelvis. there is an extensive anasarca in the subcutaneous tissues. few small renal cysts that are stable are identified in the right kidney measuring up to 10 mm. a small amount of fluid is identified surrounding the pancreatic glands, unchanged in comparison to the prior study. following administration of contrast material, there is marked cavernous transformation of the portal vein with presence of numerous venous collaterals in the hepatico-duodenal ligament encircling the biliary system. this is not significantly changed from the prior study. . impression: . 1. small new left pleural effusion. . 2. persistent moderate dilation of the intra- and extrahepatic bile ducts with tapering of the cbd at the level of the pancreatic head, most likely due to combination of the patient's known chronic pancreatitis and peri-biliary varices formation following cavernous transformation of the portal vein. . 3. status post splenectomy with splenosis nodule in the left upper quadrant. . 4. moderate dilation of the pancreatic duct which is also tapering in the pancreatic head region due to the patient's known chronic pancreatitis with associated inflammation. . 5. stable mild right hydronephrosis, also induced by the inflammatory process in the retroperitoneum. . 6. significant subcutaneous edema. . renal ultrasound: . the right kidney measures 11.5, the left kidney measures 11.2 cm. there is mild right-sided hydronephrosis without evidence of obstructing stones in the kidney or the right ureter; however, ct is more sensitive for assessment of the renal or ureteral stones. . there is no evidence of hydronephrosis or masses of the left kidney. . a foley catheter is seen in empty urinary bladder. . impression: mild right hydronephrosis, unchanged since , . no evidence of obstructing stones. . liver/billiary hida scan: . radiopharmaceutical data: 4.4 mci tc-m disida (); history: perihepatic infected fluid collection . decision: gallbladder scan followed by 18 hour delayed scan . interpretation: serial images over the abdomen show delay in uptake and excretion of the tracer into the hepatic parenchyma. activity was seen within the small bowel at 55 minutes and then within the gallbladder at 90 minutes. which is delayed in comparison to normal. . the patient returned the morning following tracer administration and there was intense tracer activity within the large bowel. there was no evidence of a leak. . impression: 1. no evidence of biliary leak. 2. delayed hepatic and gallbladder uptake. . abdominal xray: . a pigtail catheter is seen projected over the right upper quadrant. biliary stent is present. gas pattern is normal. i see no evidence of free air. gas is noted in the biliary tree which is not unexpected given the biliary stent. . impression: no evidence of obstruction. . abdominal ultrasound: . findings: note is made that this is a very limited ultrasound due to the limited acoustic window. pneumobilia is seen within the intrahepatic bile ducts. no biliary dilatation is identified. linear echogenic structures in the right upper quadrant are consistent with the patient's known drainage catheter. the visualization of the prior right upper quadrant collection is very limited, but appears to be partially resolved. . no hydronephrosis is seen on limited views of the kidneys. no fluid collections are seen within the intra-abdominal space. there are edematous soft tissues seen in the subcutaneous space along the left flank. these edematous structures correspond to the patient's area of discomfort. no discrete collection is identified. the portal vein is patent with hepatopetal flow. . impression: edematous soft tissues consistent with cellulitis seen along the left flank in a location that corresponds with the patient's discomfort. no discrete collection identified. . brief hospital course: 65m with chronic pancreatitis, complicated history w/ multiple past intra-abdominal abscesses presented w/ 3 days of severe low back pain, was septic on admission, transferred to the icu, had ir drainage of perihepatic fluid collection, transferred to the floor on from the micu. had ercp/biliary stent placed for biliary leak - perihepatic drain still draining bilious fluid, but at decreasing cc/day rate. now in acute renal failure, but slowly trending downward (cre 3.4 on discharge). new development of heme+ emesis w/o corresponding hct drop, but no other episodes. new left abdominal wall pain/tenderness w/ u/s showing abominal wall soft tissue swelling, but pain/tenderness has since resolved. vancomycin and perhaps due to zosyn as well is now resolving with downtrending cre. patient broadly covered on multiple antibiotic regimens and will be discharged on daptomycin, moxifloxacin, and fluconazole. # sepsis: patient was hypotensive but responsive to fluid boluses and did not need pressors. blood culture postive for mrsa. ir guided drainage of perihepatic fluid collection showed polymicrobial infection (+ mrsa and vanc-sensitive enterococcus). tte showed no vegetations. lactate originally 4.0, but returned to with fluids. patient originally on zosyn, fluconazole, and daptomycin. zosyn discharged due to suspicion of causing and cipro/flagyl started. daptomycin stopped and vancomycin started, but then vancomycin stopped as well do to and suspicion that vancomycin may be contributing factor. at time of discharge, all bcx negative. will discharge on daptomycin, moxifloxacin, and fluconazole. picc successfully placed on . . #biliary leak: at time of discharge, continues to drain small amounts bilious fluid from perihepatic drain. ercp showed no biliary leak or strictures but stent was placed and will need to be removed after surgery evals as outpatient. hida scan () was noncontributory and did not show an active leak. fluid cc/day has recently decreased markedly since original placement and only ~ 5 - 10 cc/day at time of discharge. . # back pain: likely musculoskeletal, no abcess on mri but a lot of djd and retrolisthesis at l5-s1. pain controlled on prn oxyxcodone and daily lidocaine patch. . # chronic pancreatitis: no signs of acute flare at this time. home pancrease replacement meds as per outpatient regimen. . # cad s/p mi: last echo in shows normal ef (>55%), no suggestion that there is a cardiogenic component to his hypotension. tte echo here showed ef >55%, normal valves except "trivial" mr. signs of vegetations or abscesses, home asa regimen continued. . # cirrhosis vs. fatty liver disease: ruq us and ct in shows echogenicity c/w cirrhosis vs. fatty liver disease. very low concern for hrs given this picture. . #left abdominal wall tenderness: patient has tenderness to minimal palpation of left lower quadrant onto left flank on . pain has since resolved. abdominal u/s shows soft tissue edema of left abdominal wall that was concerning for cellulitis, but there are no clinically correlated signs or symptoms. patient is being covered for gram (+) with daptomycin. . #acute renal failure: unclear etiology of this acute kidney injury but our suspicion is secondary to zosyn. then, patient was found to have supratherapeutic levels of vancomycin which may represent a second insult to this patient's kidneys. cre peaked at 4.8 and now downtrending. 3.4 at time of discharge. during the admission, patient's potassium was intermittently elevated in the setting of . k+ peaked at 6.3. kayexalate brought potassium into normal limits. since cre has been downtrending, patient has not required the use of kayexalate. he has been maintained on a low potassium diet of less than 1 meq of potassium daily. . # heme+ coffee ground emesis. on , patient had heme positive emesis with no other symptoms except for some nausea. this episode resolved spontaneously and there have been no repeat episodes or concerning signs/symptoms since. . medications on admission: fluconazole - 200 mg tablet - 1 tablet(s) by mouth daily furosemide - 20 mg tablet - 1 tablet(s) by mouth monday/wednesday/friday hydromorphone - 2 mg tablet - 1 tablet(s) by mouth every 8 hours do not drive while taking this medication. levothyroxine - 25 mcg tablet - 1 tablet(s) by mouth qday lipase-protease-amylase - 24,000 unit-,000 unit-,000 unit capsule, delayed release(e.c.) - 2 capsule(s) by mouth with meals 1 capsule with snac - no substitution metoclopramide - 10 mg tablet - 1 tablet(s) by mouth every 6 hours as needed for nausea moxifloxacin - 400 mg tablet - 1 tablet(s) by mouth qdaily omeprazole - (prescribed by other provider) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth daily sodium polystyrene sulfonate - powder - 30gm dose by mouth once as directed as needed for then call for instructions cvs will dispense the suspension; 15gm/60ml tamsulosin - 0.4 mg capsule, ext release 24 hr - 1 capsule(s) by mouth daily trazodone - 50 mg tablet - 1.5 tablet(s) by mouth at bedtime as needed for insomnia aspirin - 81 mg tablet, effervescent - 1 tablet(s) by mouth daily cholecalciferol (vitamin d3) - 1,000 unit capsule - 1 capsule(s) by mouth daily docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day miconazole nitrate - 2 % powder - please place along wound area three times a day as needed for moisture accumulation multivitamin with minerals - (prescribed by other provider) - tablet - 1 tablet(s) by mouth daily discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. lipase-protease-amylase 5,000-17,000 -27,000 unit capsule, delayed release(e.c.) sig: two (2) cap po tid w/meals (3 times a day with meals). disp:*180 cap(s)* refills:*2* 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for moisture accumulation. disp:*90 applications* refills:*0* 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on; 12 hours off. disp:*30 adhesive patch, medicated(s)* refills:*2* 6. acetaminophen 500 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for pain: do not give more than 2 grams within any 24 hour window. disp:*120 tablet(s)* refills:*0* 7. sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). disp:*180 tablet(s)* refills:*2* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 11. daptomycin 500 mg recon soln sig: four hundred (400) mg intravenous q48h (every 48 hours). disp:*6000 mg* refills:*2* 12. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 13. moxifloxacin 400 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. fluconazole 100 mg tablet sig: two (2) tablet po q24h (every 24 hours). disp:*60 tablet(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: sepsis due to mrsa bacteremia perihepatic fluid collection acute kidney injury discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , . we appreciated the opportunity to participate in your care at . . you were admitted for an infection of your bloodstream with a bacteria called mrsa. we also found that you had a large collection of fluid near your liver which was also infected with mrsa and another bacteria called enterococcus. antibiotics were started to treat the infection, and a drain was placed in the fluid collection. because the fluid collection contained bile, you underwent a procedure called an ercp to place a stent in your bile ducts to help relieve possible pressure in the ducts that might have contributed to the leaking bile. while you still a very small amount of bile leaking from the drain, this has slowed considerably since your admission. you have an upcoming appointment with your surgeon, dr. . at this appointment, it will be determined if the drain can be removed or not. in the meantime, we would like you to keep a record of how much fluid collects in the drain each day. also make a daily note of what that fluid looks like. . during your admission, you also suffered an injury to your kidneys. this may have been due to an antibiotic you were getting called vancomycin. you are no longer on vancomycin and you should avoid taking vancomycin in the future. your kidneys have not completely returned to their previous level of functioning, but we are hopeful that they will heal on their own with some time. your doctors a blood test called creatinine to see how they are functioning. until they have returned to , you should maintain a low potassium diet and try not to become dehydrated by drinking plenty of fluids. . you are being sent home on daptomycin, fluconazole, and moxifloxacin which you will need to take indefinitely until your infectious disease doctor thinks it is safe for you to come off these medications. we have made arrangements for your rehab facillity to help manage and administer these antibiotics until your course is complete. . start taking the following medications: - daptomycin 400mg iv every 48 hours. this dose will be adjusted as your renal function gets better. - sevelemer three times a day with meals - you may place a lidocaine patch once daily on any area where you are having pain . stop taking the following medications: - vancomycin - lasix (furosamide), the doctors at rehab restart this when your kidney function is better. - hydromorphone (dilaudid), ask the rehab doctors if need additional pain medicine - metrochlopramide (reglan), please alert the doctors if are having nausea . followup instructions: department: radiology when: monday at 9:00 am with: cat scan building: campus: east best parking: garage . department: surgical specialties when: monday at 10:30 am with: , md building: campus: east best parking: garage . department: infectious disease when: wednesday at 9:30 am with: , md building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified percutaneous abdominal drainage endoscopic insertion of stent (tube) into bile duct endoscopic insertion of stent (tube) into pancreatic duct diagnoses: hyperpotassemia anemia, unspecified coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis unspecified essential hypertension cirrhosis of liver without mention of alcohol severe sepsis unspecified acquired hypothyroidism hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) anxiety state, unspecified acute respiratory failure old myocardial infarction paralytic ileus other specified disorders of biliary tract personal history of venous thrombosis and embolism streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] do not resuscitate status hematemesis encephalopathy, unspecified hydronephrosis chronic pancreatitis other specified antibiotics causing adverse effects in therapeutic use peritoneal abscess diverticulosis of colon (without mention of hemorrhage) lumbosacral spondylosis without myelopathy unspecified vitamin d deficiency methicillin resistant staphylococcus aureus septicemia hypertrophy of breast penicillins causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to