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: iodine / heparinoids attending: chief complaint: ischemic right lower extremity major surgical or invasive procedure: thrombectomy of right iliofemoral artery. superficial femoral artery thrombectomy. intraoperative arteriography. bilateral lower extremity arteriography, rheolytic thrombectomy left common and external iliac artery,left external iliac stent placement. left thoracoscopy tracheostomy gastroscopy. attempted laparoscopy. open gastrostomy tube placement. lysis of adhesions. left thoracoscopy with removal of pleural fibrin and evacuation of empyema cavity with placement of chest tubes. history of present illness: 76 yo female s/p emergency cabg x2 is referred from due to abdominal pain and mental status changes. early on the patient was noted to develop right leg pain; worse with movement. she had previously not had a history of claudication. past medical history: 1. hypertension. 2. polymyalgia rheumatica on prednisone. 3. cerebrovascular accident in , . coronary artery disease status post coronary artery bypass grafting of two vessels on with limit to the rca and her vein graft to be lad. 5. hyperlipidemia. social history: mrs. has a large and dedicated family. family history: noncontributory physical exam: awake, alert. gcs 15 pulm: frequent rhonchi; moderate work of breathing chest: rrr, distant. 2 left chest tubes have been cut and left open to drain. abd: obese, well healing midline laparotomy incision. gastrostomy tube f functioning well. well healing bilateral groin incisions from thrombectomies. ext: warm, edematous. pertinent results: 03:56am blood wbc-12.7* rbc-3.46* hgb-10.4* hct-30.8* mcv-89 mch-30.1 mchc-33.9 rdw-15.1 plt ct-190 03:25am blood wbc-10.3 rbc-3.54* hgb-10.3* hct-32.2* mcv-91 mch-29.1 mchc-32.0 rdw-15.0 plt ct-192 03:59am blood wbc-11.9* rbc-3.60* hgb-10.7* hct-32.3* mcv-90 mch-29.6 mchc-33.1 rdw-14.6 plt ct-160 06:34am blood neuts-87.5* bands-0 lymphs-7.7* monos-1.7* eos-2.7 baso-0.3 03:56am blood plt ct-190 03:56am blood pt-13.2 ptt-26.1 inr(pt)-1.1 03:25am blood plt ct-192 03:25am blood pt-13.1 ptt-26.1 inr(pt)-1.1 03:59am blood plt ct-160 03:59am blood pt-13.0 ptt-25.0 inr(pt)-1.1 02:05am blood plt ct-66* 02:05am blood pt-17.9* ptt-61.2* inr(pt)-2.1 03:35am blood plt ct-49* 03:35am blood pt-15.9* ptt-59.2* inr(pt)-1.7 03:56am blood glucose-115* urean-26* creat-0.8 na-139 k-4.9 cl-101 hco3-29 angap-14 02:59pm blood k-4.4 03:25am blood glucose-108* urean-24* creat-0.8 na-138 k-3.2* cl-97 hco3-31* angap-13 03:59am blood glucose-92 urean-22* creat-0.8 na-138 k-4.1 cl-98 hco3-32* angap-12 02:30pm blood glucose-118* k-3.8 03:27am blood glucose-94 urean-20 creat-0.7 na-137 k-4.2 cl-96 hco3-32* angap-13 04:07am blood ck-mb-2 ctropnt-0.04* 10:24pm blood ck-mb-notdone ctropnt-0.04* 02:30pm blood ck-mb-notdone ctropnt-0.03* 03:56am blood calcium-8.2* phos-3.3 mg-2.0 03:25am blood calcium-8.5 phos-4.3 mg-2.1 03:59am blood calcium-7.9* phos-4.5 mg-1.9 12:10am blood vanco-18.9* 10:13am blood type-art po2-89 pco2-42 ph-7.46* calhco3-31* base xs-5 05:13pm blood type-art temp-37.2 tidal v-400 peep-5 po2-pnd pco2-pnd ph-pnd calhco3-pnd base xs-pnd intubat-intubated 11:47am blood type-art rates-/28 tidal v-500 peep-5 o2-40 po2-83* pco2-33* ph-7.48* calhco3-25 base xs-1 02:14am blood type-art temp-37.1 rates-14/6 tidal v-55 peep-5 o2-50 po2-124* pco2-35 ph-7.48* calhco3-27 base xs-3 -assist/con intubat-intubated time taken not noted log-in date/time: 4:06 pm swab site: pleural l. pleural effusion. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): a swab is not the optimal specimen collection to evaluate body fluids. escherichia coli. sparse growth. identification and sensitivities performed on culture # 174-8037m (). acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): fungal culture (preliminary): no fungus isolated. a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. inappropriate specimen for fungal smear (koh). anaerobic culture (final ): specimen not transported anaerobically. test cancelled, patient credited. 2:00 pm tissue pleural fibrin. gram stain (final ): this is a corrected report (). 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram negative rod(s). previously reported as. no microorganisms seen. tissue (final ): escherichia coli. moderate growth. identification and sensitivities performed on culture # 174-8037m (). anaerobic culture (final ): due to laboratory error, unable to process. anaerobes are screened for in the tissue culture. test cancelled, patient credited. acid fast culture (pending): acid fast smear (final ): no acid fast bacilli seen on direct smear. fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): no fungal elements seen. 4:45 pm sputum **final report ** gram stain (final ): <10 pmns and <10 epithelial cells/100x field. no microorganisms seen. quality of specimen cannot be assessed. respiratory culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. oropharyngeal flora absent. escherichia coli. sparse growth. of two colonial morphologies. yeast. sparse growth. staph aureus coag +. rare growth. sensitivities performed on culture # (). sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 4:16 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): rare growth oropharyngeal flora. gram negative rod(s). sparse growth. identification and sensitivities performed on culture # . yeast. sparse growth. staph aureus coag +. sparse growth. sensitivities performed on culture # . 12:38 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. heavy growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. escherichia coli. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | escherichia coli | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s <=1 s levofloxacin---------- =>8 r =>8 r meropenem------------- <=0.25 s oxacillin------------- =>4 r penicillin------------ =>0.5 r piperacillin---------- <=4 s piperacillin/tazo----- <=4 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s vancomycin------------ <=1 s 6:34 pm sputum site: endotracheal source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. respiratory culture (final ): oropharyngeal flora absent. escherichia coli. moderate growth. staph aureus coag +. moderate growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | staph aureus coag + | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r erythromycin---------- =>8 r gentamicin------------ <=1 s <=0.5 s levofloxacin---------- =>8 r =>8 r meropenem-------------<=0.25 s oxacillin------------- =>4 r penicillin------------ =>0.5 r piperacillin---------- <=4 s piperacillin/tazo----- <=4 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s vancomycin------------ <=1 s 10:00a test result heparin dependent antibodies positive comment: positive for heparin pf4 antibody reported to , rn 2 pm. complete report on file in the laboratory. brief hospital course: a brief summary of the patient's course is summarized below by problem: 1. heparin induced thrombocytopenia invasive procedures relating to the problem: thrombectomy of right iliofemoral artery. superficial femoral artery thrombectomy. intraoperative arteriography. bilateral lower extremity arteriography, rheolytic thrombectomy left common and external iliac artery,left external iliac stent placement. heparin induced thrombocytopenia was recognized as the etiology of the patient's presenting problem of bilateral lower extremity ischemia. she underwent the above listed interventions and was anticoagulated with lepirudin, plavix, and aspirin. this was continued until a recalcitrant bleeding duodenal ulcer developed after which she was maintained on aspirin only for the majority of her remaining hospital stay. after the initial treatment of the hit, there were no recurrent clinical sequels of her hit. 2. duodenal ulcer, bleeding s/p endoscopic treatment with cautery and epinephrine injection x 3 after anticoagulation for the patient's hit and bilateral lower extremity arterial thromboses, she developed significant ugi bleeding. it was ultimately controlled with a combination of multiple upper endoscopies, and cessation of her lepirudin and plavix. endoscopic evaluation revealed a duodenal ulcer and a gastric ulcer as the source of her bleeding. the duodenal ulcer was the primary contributor. prior to discharge, she was restarted on coumadin 5 mg nightly and has tolerated resumption of the coumadin without evidence of recurrence of her bleeding. 3. supraventricular tachycardia throughout her hospital stay, the patient has had svt on occasion but this has improved significantly with beta blockade, amiodarone, and diuresis. she is being discharged with amiodarone but it may be possible to discontinue this after further resolution of her current illness. 4. subacute subdural hematoma the patient developed a diminished level of consciousness and increased agitation several weeks into her admission. this was evaluated with a ct scan of the head. bilateral subacute subdural hematomas were demonstrated. a neurosurgical consult was obtained. no neurosurgical intervention was recommended. with time her sensorium has improved dramatically. this is considered an inactive issue. 6. acute blood loss anemia requiring transfusion the patient's blood loss was secondary to her upper gi bleeding. she is currently hemostatic. 7. left pleural effusion requiring thoracentesis, ultimately requiring video assisted thoracoscopy with partial decortication and chest tube placement: left thoracoscopy left thoracoscopy with removal of pleural fibrin and evacuation of empyema cavity with placement of chest tubes the patient had developed a chronic left thoracic pleural effusion following her cabg. ultimately this became an infected collection and was found, following vats, to contain e. coli. chest tubes were left in place following the vats procedure. these have had diminishing output since the day of the procedure. the thoracic surgery team has taken the tubes off of waterseal as the collections do not communicate significantly with the patient's airway. these will be removed, an inch per week, until the chest tubes are completely removed. summation: the patient has undergone a series of insults following her emergency cabg on beginning with bilateral lower extremity ischemia due to heparin induced thrombocytopenia, bleeding duodenal ulcer and bilateral subdural hematomas probably secondary to anticoagulation, and multiple foci of infection with the left empyema representing the largest one. taken together these injuries have required a prolonged course accelerated to some extent by tracheostomy and gastrostomy. ms. has made major progress from a serious illness and is being transferred to in fair, stable, but improving condition. medications on admission: 1. lasix 20 mg b.i.d. 2. aspirin 325 mg daily. 3. captopril 25 mg t.i.d. 4. prednisone 20 mg daily. 5. lopressor 25 mg daily. 6. kcl 40 mg daily. 7. protonix daily 40 mg. discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 2. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 3. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal qd (once a day) as needed. 5. prednisone 5 mg tablet sig: one (1) tablet po qd (once a day). 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 7. amiodarone hcl 200 mg tablet sig: one (1) tablet po qd (once a day). 8. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day): d/c after . tablet(s) 9. metoclopramide hcl 5 mg/5 ml solution sig: one (1) po qid (4 times a day). 10. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours): discontinue after . 11. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 12. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 13. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 14. ondansetron hcl 2 mg/ml solution sig: one (1) intravenous q6h (every 6 hours) as needed for nausea. 15. furosemide 10 mg/ml solution sig: one (1) injection tid (3 times a day). 16. potassium chloride 20 meq packet sig: one (1) po twice a day: titrate as needed based on diuretic usage; potassium levels. discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. duodenal ulcer, bleeding status post endoscopic treatment with cautery and epinephrine injection x 3 2. heparin induced thrombocytopenia, (hit type 2), white clot syndrome 3. supraventricular tachycardia 4. acute bilateral lower extremity ischemia s/p bilateral groin cutdown and thrombectomy 5. subacute subdural hematoma 6. acute blood loss anemia requiring transfusion 7. left pleural effusion requiring thoracentesis, ultimately requiring video assisted thoracoscopy with partial decortication and chest tube placement 8. left chest empyema discharge condition: fair discharge instructions: 1. routine trach care 2. anticoagulate with coumadin to goal inr 2.0-3.0 3. activity as tolerated 4. routine gastrostomy care 5. tube feeds at goal rate 6. remove abdominal staples after followup instructions: , m.d, general surgery ( , m.d., thoracic surgery 2a ( , m.d., hematology ( , m.d., vascular surgery ( , md, cardiothoracic surgery ( procedure: enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries temporary tracheostomy endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding other incision of pleura other incision of pleura incision of vessel, lower limb arteries other lysis of peritoneal adhesions insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) repair of blood vessel with synthetic patch graft other gastrostomy injection or infusion of oxazolidinone class of antibiotics diagnoses: unspecified pleural effusion acute posthemorrhagic anemia subdural hemorrhage empyema without mention of fistula embolism and thrombosis of iliac artery acute duodenal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to