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: history of present illness: this 61-year-old male with a history of chronic obstructive pulmonary disease was admitted to on , for an exacerbation of her pulmonary problems. underwent an substernal chest pain; however, he was only able to complete two minutes on protocol before having st depressions and chest pain. on , he underwent cardiac catheterization which revealed a 60% to 70% stenosis of his left main, as well as greater than 90% stenosis of his right coronary artery, and greater than 60% of his left circumflex. , where he underwent coronary artery bypass graft times three. his postoperative course was somewhat complicated by his chronic obstructive pulmonary disease; however, he was managed with bronchodilators and antibiotics for a left lower lobe consolidation and positive sputum for hemophilus. on , the patient was discharged to a rehabilitation facility in stable condition. while at that facility, the patient and his wife were not satisfied with the quality of care being provided there, and was brought to hospital's emergency department with complaints of chest discomfort which was exacerbated with movement and coughing. the emergency department evaluation felt that his pain was due to his sternotomy incision and had planned to discharge him back to the rehabilitation facility. however, the patient and his wife did not agree to that. since there was some questionable cellulitis of his right lower extremity, the patient was transferred to . he had complained of low-grade fever but denied chills, sweats, or any discharge from his incision. past medical history: 1. chronic obstructive pulmonary disease with multiple hospitalizations and previous steroid use. 2. hypertension. 3. sleep apnea. 4. gout. 5. status post methicillin-resistant staphylococcus aureus pneumonia. 6. status post appendectomy. 7. status post umbilical herniorrhaphy. medications on admission: medications upon admission to the hospital were lopressor 12.5 mg p.o. b.i.d., lasix 40 mg p.o. t.i.d., potassium chloride 20 meq p.o. b.i.d., aspirin 81 mg p.o. q.d., levofloxacin 500 mg p.o. q.d. times eight days, percocet one to two tablets p.o. q.3-4h. p.r.n. for pain, colace 100 mg p.o. b.i.d., paxil 20 mg p.o. q.d., allopurinol 100 mg p.o. q.d., singulair 10 mg p.o. q.d., serevent inhaler 1 puff to 2 puffs q.4h. p.r.n., and albuterol nebulizer treatment q.i.d. p.r.n. physical examination on admission: upon admission to the hospital temperature was 99.2, pulse 76, normal sinus rhythm, blood pressure 129/67, respiratory rate 20, oxygen saturation 91% on room air. the patient was a 61-year-old male in no apparent distress, was alert and oriented times three. his neck was supple with no bruits noted. lungs revealed wheezes bilaterally. his sternum was stable. his incision was clean, dry, and intact. coronary examination revealed a regular rate and rhythm, with no murmurs, rubs or gallops. the abdomen was soft, nontender, and nondistended. his extremities were warm and well perfused. his incision was clean, dry, and intact with no purulent discharge of significant erythema. laboratory data on admission: laboratory values upon admission to the hospital were white blood cell count 16.8, hematocrit 28.4. potassium 4.6, bun 18, creatinine 0.8. hospital course: the patient was admitted to the hospital for physical therapy as well as wound checks and pulmonary toilet. in the early morning on hospital day two (), the patient had some problems with disorientation after receiving ambien for sleep. the patient did receive some haldol to treat this. the patient remained hemodynamically stable, and the patient was monitored by a one-to-one sitter in his room. later in the day the patient was alert and oriented, in no apparent distress. he remained to be wheezing bilaterally, but otherwise had an unremarkable physical examination. on , the patient continued to have intermittent periods of delirium. it was noted upon physical examination that day that there was a small sternal click at the inferior portion of his sternum which was elicited with coughing. the patient's incision had remained clean, dry, and intact. his white blood cell count had risen to 18.6, and the patient was fully cultured at that time. two blood cultures which were obtained on , revealed coagulase-negative staphylococcus aureus. sputum culture on that same day was unremarkable. over the next few days, the patient had a low-grade fever between 99 degrees and 101 degrees and continued to have a sternal click without wound drainage or erythema. the patient was empirically started on vancomycin on , due to staphylococcus species. at that time the cultures were not finalized; however, they ultimately proved to oxacillin-resistant staphylococcus aureus. on , on hospital day five, postoperative nine, the patient complained of a clicking painful sensation in his chest. this persisted throughout the next day as well, on , when he continued to complain of sternal discomfort. the patient had completed his course of levofloxacin and was on day three of vancomycin at that time. on , the patient continued to have a sternal click with pain at the site and positive blood cultures. the patient was taken to the operating room on , due to sternal dehiscence. he underwent a sternal wound debridement with a robicsek weave of his sternum by dr. . please see the operative report for full details of surgical procedure. the patient was extubated and brought to the intensive care unit where he remained for approximately 24 hours. he remained hemodynamically stable. his white blood cell count had dropped to 9.2. on , his pulmonary status was stable. his creatinine had elevated slightly from a baseline of 1.1 to 1.4 at this time. he had adequate urine output at the time and was transferred from the intensive care unit to the telemetry floor, six, on . on , on postoperative day two, the patient still had complaints of pain; however, was hemodynamically stable. his white blood cell count at that time was 13.5. the patient had remained essentially afebrile to having a low-grade fever of about 100 degrees. his oxygen saturation was adequate, and his vital signs were stable. the patient was noted to have some serosanguineous drainage from the middle portion of his sternal wound at that time. the patient was maintained on intravenous vancomycin for the methicillin-resistant staphylococcus aureus which was noted in his previous blood cultures. he was given morphine for pain control. he was on lopressor and was continuing to diuresed. on , a peripherally inserted central catheter line was inserted in the interventional radiology department because it was felt that the patient would need to continue on a full 4-week to 6-week course of vancomycin. on , the patient remained hemodynamically stable; although, he was beginning to have an elevated fever to 101.2, and he continued to complain of sternal pain. he was noted to still have mild amounts of serosanguineous drainage fro his sternal incision. on , on postoperative day four, the patient was more comfortable. he had been given dilaudid for pain control. he was noted to have some degree of peri-incisional erythema of his sternotomy incision. his sternum was stable at that time. the patient had no other significant complaints. his white blood cell count was 12.4. his creatinine had risen again to 1.5 at this time. he was still being continued on vancomycin. on , the house officer was called to see the patient due to agitation. upon arrival for examination the patient was alert and oriented; however, he did state that he felt confused earlier, but this had resolved. this was felt likely to be a complication of the narcotics which he had been given for pain control. the narcotics were discontinued at this time, and he was started on ultram and toradol for pain control. on , the patient's creatinine was noted to have risen from 1.4 on the previous day to 2.3. this was felt to be attributable to the toradol which was discontinued at that time. the patient remained alert. his sternum remained dry with some peri-incisional erythema present. the patient stated he felt better. on , a renal medicine consultation was obtained due to continued rise in creatinine which was 3.8 on . it was their feeling that the patient had been exposed to nephrotoxic drugs, specifically nonsteroidal antiinflammatory drugs such as ibuprofen, toradol, celebrex, and vioxx over the past number of days, and it was their recommendation to repeat urinalysis as well as urine cultures, to hold all nephrotoxic drugs, to follow the patient's electrolytes on a daily basis, to maintain a systolic blood pressure of 110, and to renally dose all of his medications as well as to follow strict measurements of intake and output. on , the patient's creatinine continued to rise and was at 4.4. the patient's vancomycin level was 33.3, and his vancomycin was held with the plan of daily levels to be drawn, and for him not to be dosed again until his level dropped below 15. the patient was transfused packed red blood cells for a hematocrit which had drifted down over the previous two days to 21.1. it was the renal service's feeling that there was no indication for dialysis but to continue the treatments which had been initiated; that was to continue to hold all nonsteroidal drugs, and to renally dose medications, and to continue to follow electrolytes, urine output, and creatinine daily. the patient continued to receive bronchodilator treatments due to his underlying pulmonary disease. on , the patient remained with a low-grade fever of about 100. his creatinine had leveled off at 4.5. he remained with no sternal drainage. his sternum was stable with no click; however, he continued to have some erythema of the sternal incision. on , the patient had progressed somewhat with level of ambulation. his pain was fairly well controlled. his creatinine had stabilized at 4.5. while there was no drainage, there remained erythema at the sternal incision. the patient was started on levofloxacin empirically for what was presumed a sternal wound cellulitis. on , the patient was noted to have more episodes of agitation and disorientation. the patient also began to start complaining of increased sternal pain exacerbated with cough and deep breathing which he had been encouraged to do because of his pulmonary status, and history of chronic obstructive pulmonary disease, and need for bronchodilators, and pulmonary toilet. on , the patient was noted to have some increasing erythema over his sternal incision, and a plastic surgery consultation was obtained on . it was their assessment that the patient should return to the operating room for sternal wound debridement and vacuum-assisted dressing placement. on , the patient was also noted to have a slight increase in his creatinine despite holding of nephrotoxic drugs. he was up to 4.8 at this time; although, it was still felt that there was no indication to initiate dialysis since the patient was not acidemic nor hyperkalemic at that time. on , the patient was seen by dr. (plastic surgeon). it was his recommendation at that time to consider a chest ct scan to rule out mediastinitis due to the continued erythema with the plan of taking him for surgical debridement if his erythema had not improved or had increased over the next few days. on , the patient was noted to have increased erythema with some serosanguineous drainage beginning to come from the sternal incision, and this was sent for culture, and the gram stain revealed staphylococcus species at this time. dr. from the plastic surgery service did evaluate the patient on . he reported that the ct scan showed no retrosternal collection, and he felt there was no urgency to do anything other than conservative treatment at that time. it was his recommendation that if the patient had increased draining or became febrile that he may need to return to the operating room for a wound debridement. on , the patient's serum creatinine had risen to 5.1, and while his renal function had been deteriorating there was still no indication for renal replacement therapy at that time. an infectious disease consultation was obtained on . their recommendation was to continue treating the patient with intravenous vancomycin to be dosed by levels and to add gram-negative coverage only if there was a change in the patient's clinical status. on , the patient was noted to have an increased amount of drainage from the middle portion of his sternal incision. the staples in that area had been removed, and there was continued erythema. wet-to-dry normal saline dressings had been initiated. on , the plastic surgery service recommended at that time that the patient be taken to the operating room for an operative washout of his sternal incision. this was due to continued erythema and drainage. the patient's creatinine at this time had started to decline and was down to 4.3 on , and his urine output had also begun to increase. the patient was taken to operating room on , due to continued sternal wound erythema and drainage. the patient underwent a sternal debridement by dr. and dr. as well as placement of a vacuum device by plastic surgerye. please see the operative report for full details of the surgical procedure. the patient was transported from the operating room to the intensive care unit, extubated, and hemodynamically stable with a vacuum-assist device in place to the sternal wound. at approximately 9:20 that evening, the patient had a strong cough and the suction container attached to the vacuum-assist device began to fill with blood quickly. the house officers were called and responded to the bedside within minutes. the vacuum dressing was removed, and the patient's chest was opened completely, and it was noted at that time that there was a tear in the right ventricle that was felt to be possibly secondary to adhesions following the coughing. the patient did suffer a full cardiopulmonary arrest at that time. he was intubated, but he was unable to be resuscitated. dr. was notified and came to the hospital and spoke with the family at that time at length to notify them of the events which had occurred. the patient did expire on . permission for autopsy was granted and arrangements for the autopsy were made. condition at discharge: expired. discharge diagnoses: right ventricular rupture, status post sternal wound infection/dehiscence/sternal debridement. , m.d. dictated by: medquist36 d: 13:41 t: 05:13 job#: procedure: other repair of chest wall incision of chest wall total ostectomy, scapula, clavicle, and thorax [ribs and sternum] cardiopulmonary resuscitation, not otherwise specified diagnoses: other postoperative infection unspecified essential hypertension chronic airway obstruction, not elsewhere classified cardiac arrest surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation unspecified sleep apnea acute osteomyelitis, other specified sites 

Answer: The patient is high likely exposed to