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 is an 87 year old man with severe peripheral vascular disease, congestive heart failure and cardiomyopathy, atrial fibrillation, hypertension, hypercholesterolemia, chronic renal insufficiency, diabetes, history of upper gastrointestinal bleed and lower extremity wound who was recently discharged from at the end of for clostridium difficile colitis and upper gastrointestinal bleed who now presents with acute and chronic renal failure, hyperkalemia, worsening lower extremity pain and persistent diarrhea from rehabilitation. in the emergency department, he was hemodynamically stable. his lower extremity ulcers had a pus exudate. he had a urinalysis consistent with urinary tract infection with thick milky colored urine and was found to have diarrhea. he also had a potassium of 7.3. he was given d50 plus insulin plus kayexalate, plus calcium carbonate and zosyn times one dose. additional history reveals his last admission from through , he was positive for clostridium difficile on and had bloody stools, was given intravenous levofloxacin and flagyl and p.o. vancomycin. he also underwent esophagogastroduodenoscopy on , which showed the lower one-third of his esophagus had ulcers plus duodenitis. he was sent out on p.o. vancomycin. after speaking with his daughter the patient has had bloody stools at , has been receiving increasing doses of lasix via phone conversations with primary care doctors. he has a history of having a colonoscopy in , positive for only a small benign appearing polyp and reports no fevers, weight loss, nausea, vomiting, chest pain or shortness of breath. he is not on home oxygen but is requiring oxygen upon interviewing. no belly pain. he does have pain in his lower extremities bilaterally with his wounds. he is not very ambulatory at . past medical history: 1. peripheral vascular disease, status post left superficial femoral artery stent; 2. congestive heart failure in idiopathic cardiomyopathy with 20 to 30%; 3. history of clostridium difficile at the end of treated for 30 days with p.o. vancomycin; 4. history of upper gastrointestinal bleed; 5. chronic atrial fibrillation; 6. chronic renal insufficiency with a baseline creatinine of 2.0; 7. diabetes type 2, diet-controlled; 8. hypertension; 9. hyperlipidemia. allergies: darvocet and percocet and essentially all narcotics as they cause altered mental status. medications: outpatient medications include lipitor 10 mg a day, nephrocaps, plavix 75 mg a day, allopurinol, questran, digoxin 0.125 three times a week, flomax, coumadin, rocaltrol, lopressor 12.5, aspirin 325, epogen. social history: he is a retired dentist, no smoking, alcohol or drug history. his daughter is intensely involved with his medical care. physical examination: on examination he weighed 85 kg, temperature 95.3, temperature maximum 97.6, heartrate in the 60s to 70s and atrial fibrillation, blood pressure 113/135/50 to 60s, sating anywhere from 95 to 99% on 2 liters of nasal cannula, guaiac positive stool. generally he has a flat, depressed affect. neck: no jugulovenous pressure was appreciated, no nodules or lymphadenopathy. head, eyes, ears, nose and throat: clear oropharynx, moist mucous membranes, pale conjunctiva, anicteric sclera, small pupils bilaterally but reactive. extraocular movements intact. chest examination, decreased breathsounds with bibasilar crackles bilaterally. cardiovascular, irregular rhythm with a holosystolic ii/vi murmur. abdomen was soft, positive bowel sounds, nontender, nondistended. extremities, erythema to below the knees with a temperature gradient compared to the thighs, bandages, foul odor coming from the siege, no edema. underneath the bandages find exposed bone and tendon. neurological examination, cranial nerves ii through xii appear intact, gross upper extremity strength 5/5 unable to test lower extremity strength secondary to his chronic ulcers and pain. sensation to light touch intact grossly throughout. gait not tested. the patient is not ambulatory with multiple ulcers on bilateral lower extremities. laboratory data: pertinent laboratory data reveals he was admitted with a white count of 24,000 at maximum which subsequently dwindled to 8.4 upon discharge. his hematocrit was metered at 26.0, however, was stable ranging from 30 to 32 upon discharge, platelets stable. coagulation profile, he was admitted with an inr of 2.0, held coumadin secondary to gastrointestinal bleeding and inr fell to within the normal range. chem-7, the potassium was 7.3 upon admission and upon discharge is within normal range. sodium initially high at 146 and now within normal limits, bun initially in the 100s, 104, but within normal limits upon discharge, creatinine maximum value was 8.6, down to the range of 4 upon discharge. calcium, magnesium and phosphorus were followed and were abnormal. his urinalysis showed more than 50 white blood cells, moderate leukocyte esterase and liver function test were within normal limits. digoxin level was 1.0. urine sodium 58, creatinine 58. culture data, stool negative for clostridium difficile on , , and stool culture from was positive for gram negative rods, this was sent to the state laboratory for further identification and it is not back yet upon discharge. no campylobacter, negative for clostridium difficile. culture data from the urine grew out yeast, otherwise negative. culture data from blood showed no growth on , no fungus or mycobacterium, no growth from , again and one bottle with corynebacterium diphtheroids 1 out of 2 from . swab cultures taken from wounds grew out pseudomonas and staphylococcus aureus coagulase positive, sensitive to vancomycin and a pseudomonas sensitive to zosyn, multiple cultures were taken. studies, renal ultrasound consistent with chronic renal failure. chest x-ray, cardiomegaly, left atelectasis and effusion, pulmonary edema. he had a stress mibi in , moderate reversible inferior wall defects, no electrocardiogram changes or symptoms. ejection fraction was approximately 30%, diffuse hypokinesis. on , he had a catheterization that showed critical stenosis of the right superficial femoral artery even after stenting. hospital course: 1. renal failure - originally it was suspected that this was a prerenal etiology as the patient had increased diarrhea and had increasing diuretic regimen while at . the patient became anuric. other causes of renal failure were investigated including spep and upep, which spep was consistent with inflammatory response, upep showed no light change. hepatitic panel was negative with the exception of the hepatitis b surface antibody, not indicating disease, indicating immunity. the fena, fractional excretion of sodium was 4.6%, urine eosinophils were positive moderately, renal ultrasound was normal. renal service was consulted and it was decided secondary to the patient's volume overload and the persistent hyperkalemia that this patient undergo hemodialysis, thus a right internal jugular quinton catheter was placed on for hemodialysis and the patient received three episodes of hemodialysis in a row and then was converted to three times per week schedule, saturday, tuesday and thursday. there was a plan for vascular surgeon, dr. to evaluate the patient for arteriovenous fistula and graft. vein mapping was done on . a tunneled catheter and picc line were placed by interventional radiology on . this patient was maintained on calcium acetate and nephrocaps and epogen and calcitriol are given at hemodialysis. the patient has urinary tract infection and was treated with zosyn renally. zosyn was also used to treat the wound cultures as well. this patient also had a high parathyroid level of 199, likely secondary to renal pathology. 2. gastrointestinal bleeding - this patient received five units of fresh frozen plasma and one unit of red blood cells in the intensive care unit for gastrointestinal bleeding and guaiac positive stools following hematocrit. however, after his stay in the intensive care unit while on the floor he was stable and had no recurrent episodes of bleeding, his hematocrit remained stable. multiple clostridium difficile toxins were negative. so, clostridium difficile toxin b was sent to an outside laboratory and is currently pending. his stool culture from is growing gram negative rods. this was sent to the state laboratory for infectious disease, there is question of shigella possibly. this should be followed up. he was maintained on a proton pump inhibitor. stool osmolality, serum osmolality, sodium and potassium was obtained. he was found to have a stool osmolar gap of 43 indicating a secretory component to his diarrhea. for the diarrhea he had a colonoscopy on , which showed no pseudomembranes and only two benign appearing polyps. biopsies were taken, not available at the time of discharge. thus, he was treated with imodium for his chronic diarrhea. it was felt important to treat this as his nutritional status is imperative in order to help heal his wound. 3. peripheral vascular disease - vascular surgery was consulted. this patient has exposed bone and tendon which is the equivalent of osteomyelitis. he was treated with zosyn and vancomycin. zosyn was started on and is renally dosed. vancomycin is renally dosed based on a vancomycin level which is checked every day. once the level dips below 15, the patient receives another dose, 1 gm of intravenous vancomycin. multiple blood cultures taken from the wounds are positive for pseudomonas and coagulase positive staphylococcus aureus sensitive to zosyn and vancomycin respectively. abi was done and he had an abi ratio of 0.61 on the right and 0.83 on the left. vascular recommended dry gauze changes with accuzyme prn and bedside debridement was performed. ultimately they recommended bilateral above-the-knee amputations, however, it was decided with the primary team that it would be best to try a six week course of intravenous antibiotics before attempting bilateral amputations. amputation would severely limit this patient's potential ability to ambulate and quality of life. 4. cardiology - this patient has atrial fibrillation and congestive heart failure with an ejection fraction of 20 to 30%. his intakes and outputs are monitored and his oxygen saturations are monitored. his volume overload when he originally presented with the chest x-ray showed some pulmonary edema, increased pulmonary vasculature. with hemodialysis he was able to remove a lot of that fluid and his saturations became better. he was sating 92 to 93% on room air upon discharge. his coumadin for his atrial fibrillation was held secondary to his gastrointestinal bleeding. he was continued on his statin, metoprolol 12.5 b.i.d. aspirin was held for his colonoscopy but restarted as baby aspirin 81 mg. 5. diabetes - regular insulin sliding scale, fingersticks b.i.d., he did not require much insulin at all. 6. neurological - he was originally given a low dose fentanyl patch for his lower extremity pain, however, this resulted in altered mental status, so this was discontinued. he was started on remeron 7.5 mg at night to increase his appetite, help with depression and sleep. he is sleeping better and his appetite is up. 7. fluids, electrolytes and nutrition - nutrition was consulted and originally recommended tube feeds since the patient was not eating, he had a decreased appetite, however, nutrition came by later on in his hospitalization and performed a three day calorie count which found that he was meeting his caloric needs, thus tube feeds are not needed. it is thought that the additional of remeron as well helped his appetite as well. he was maintained on folic acid, zinc, ascorbic acid. a speech and swallow evaluation was performed and this showed no issues with swallowing. 8. prophylaxis - he was kept on proton pump inhibitor, subcutaneous heparin and scheduled tylenol for pain. code status: he is full code, his daughter is his health care proxy. discharge diagnosis: 1. renal failure 2. peripheral vascular disease 3. atrial fibrillation 4. hypertension 5. diabetes type 2 6. chronic lower extremity ulceration secondary to peripheral vascular disease 7. hypercholesterolemia the rest of this dictation summary will be dictated at a later date. , md dictated by: medquist36 procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis excisional debridement of wound, infection, or burn closed [endoscopic] biopsy of large intestine nonexcisional debridement of wound, infection or burn transfusion of packed cells transfusion of other serum diagnoses: hyperpotassemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage of gastrointestinal tract, unspecified acute vascular insufficiency of intestine other and unspecified coagulation defects 

Answer: The patient is high likely exposed to