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: keflex / ciprofloxacin / ertapenem / meropenem attending: chief complaint: acute renal failure, urinary tract infection major surgical or invasive procedure: bedside hd line placement, ir guided hd line placement, ir guided tunnelled hd line placement, picc line placement, paracentesis, central line placement, intubation, ng tube placement history of present illness: ms is a 60 year old woman with cirrhosis methotrexate (for psoriatic arthritis) and hepatitis c who initially presented with acute on chronic renal failure; her course has been complicated by uti, bacteremia, respiratory distress requiring icu transfer as well as worsening arf requiring hd who is now stable for call out of the icu to the floor. . the patient was recently admitted to from to for an infected bullae. the patient was then discharged to rehab, where she was feeling well and had no specific complaints. the patient had routine labs drawn on , which a cr of 3.0 (baseline 1.8-2.0). . on admission she was found to have a uti which grew pseudomonas, klebsiella, and esbl e. coli on straight cath. she was initially treated with first with unasyn but developed a diffuse rash. she was then switched to aztreonam due to allergies to cephalosporins, penicillins, and fluoroquinolones but the culture ultimately grew resistent esbl ecoli and pseudomonas. she was switched to meropenem but developed diffuse erythroderma with eosinophilia after 3 days. the meropenem was stopped but a repeat ua and cx was notable only for yeast and no signs of ongoing infection. she then became increasingly encephalopathic and developed a fever. her blood cultures grew coag negative staph x3 bottles and she was started on vancomycin. she also being treated for hepatorenal syndrome with albumin, midodrine, and octreotide. unfortunately her renal function continued to decline and it was felt that she would need hd. the renal team was unable to place an hd cath at the bedside on friday . she has some post procedure bleeding and was transfused 2u prbc the following day. she developed respiratory distress thought to be due to volume overload on sat . abg on ra 7.36/27/63. she did not respond to lasix 80 iv, and was therefore transferred to the icu. . in the icu a nitro gtt was initiated with relief of her distress. on , the patient self d/c'd her picc line. an ir guided temporary hd cath with a vip port was placed. she underwent her first dialysis session on . she developed a large hemorrhagic bulla at the site of her hd cath. ddavp was given. hemolysis labs were difficult to interpret in the setting of esld. wound care was consulted. her o2 was weaned to 2l nc (from 4l). blood culture from grew vre and her antibiotics were changed to dapto. she also was noted to have am hypoglycemia so her evening glargine was decreased to 10u from 20u. her course has further been complicated by ongoing encephalopathy which responded to lactulose. . on the floor now she is comfortable on 2l nc but remains encephalopathic. she has no particular complaints but is a&o x 1. she continues to require hd with poor uop. past medical history: hepatitis c, genotype 1: diagnosed in with last vl 263,000 in cirrhosis (methotrexate and hepatitis c induced) s/p tips, complicated by hepatic encephalopathy and ascites chronic kidney disease with baseline cr 1.8-2.0 diastolic chf: grade i diastolic dysfunction , ef 75% esophageal varices per report; however, egd reports normal esophagus psoriasis with arthropathy - s/p methotrexate x 15 years (mtx d/c in 12.07 when patient developed ascites and now uses halobetasol cream) anemia with baseline hct 25-30 thyroid nodule 2.2cm identified on ultrasound foot drop from peroneal nerve injury during tips procedure (per dc summary) social history: quit smoking in . no alcohol problems, no drugs. formerly taught hairdressing. had been living with her son and father until recent admission after which she went to . uses a walker but has a very difficult time getting around. family history: no known history of liver disease physical exam: general: elderly, pleasant woman in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck: supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. harsh 3/6 systolic murmur. nl s1 and s2 lungs: ctab, good air movement biaterally. abdomen: nabs. soft. diffusely distended. non-tender. extremities: 3+ edema bilaterally. bullae on lower extremities bilaterally, covered with gauze. skin: diffusely dry skin with multiple skin tears. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred. no asterixis psych: listens and responds to questions appropriately, pleasant pertinent results: (from nh) hct 26 na 129 k 5.8 creat 3.03 (baseline 2.0-2.4) admission labs: 12:23pm blood wbc-19.6*# rbc-2.90* hgb-8.8* hct-26.3* mcv-91 mch-30.4 mchc-33.6 rdw-16.7* plt ct-126* 12:23pm blood pt-19.6* ptt-47.4* inr(pt)-1.8* 12:23pm blood glucose-127* urean-40* creat-3.4*# na-130* k-5.4* cl-103 hco3-20* angap-12 12:23pm blood alt-31 ast-43* ld(ldh)-216 alkphos-159* totbili-1.0 12:23pm blood albumin-2.3* calcium-9.1 phos-3.9 mg-1.9 . discharge labs: 05:15am blood wbc-11.2* rbc-1.93* hgb-6.2* hct-18.1* mcv-94 mch-32.4* mchc-34.5 rdw-21.0* plt ct-89* 05:15am blood pt-20.9* ptt-50.9* inr(pt)-2.0* 05:15am blood glucose-50* urean-15 creat-3.5*# na-139 k-3.5 cl-100 hco3-29 angap-14 05:15am blood alt-20 ast-26 ld(ldh)-175 alkphos-111 totbili-1.9* 05:15am blood albumin-3.2* calcium-9.8 phos-4.3# mg-1.6 . culture data: 2:15 pm urine source: catheter. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. aztreonam = r. klebsiella pneumoniae. >100,000 organisms/ml. aztreonam = <=1 mcg/ml = s. pseudomonas aeruginosa. >100,000 organisms/ml. sensitivities: mic expressed in mcg/ml escherichia coli | klebsiella pneumoniae | | pseudomonas aeruginosa | | | amikacin-------------- 8 s ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s 8 s cefazolin------------- r <=4 s cefepime-------------- r <=1 s 32 r ceftazidime----------- r <=1 s 32 r ceftriaxone----------- r <=1 s cefuroxime------------ 32 r 2 s ciprofloxacin--------- =>4 r <=0.25 s =>4 r gentamicin------------ <=1 s <=1 s =>16 r meropenem-------------<=0.25 s <=0.25 s 4 s nitrofurantoin-------- <=16 s 32 s piperacillin---------- r =>128 r piperacillin/tazo----- <=4 s <=4 s =>128 r tobramycin------------ <=1 s <=1 s =>16 r trimethoprim/sulfa---- <=1 s =>16 r . 8:40 am blood culture **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. anaerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. . 10:35 am urine source: catheter. **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml. . 1:56 pm blood culture source: line-picc. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. final sensitivities. sensitivities: mic expressed in mcg/ml staphylococcus, coagulase negative | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ 4 s levofloxacin---------- 4 r oxacillin------------- =>4 r rifampin-------------- =>32 r tetracycline---------- 2 s vancomycin------------ 2 s anaerobic bottle gram stain (final ): gram positive cocci in clusters. aerobic bottle gram stain (final ): gram positive cocci in clusters. . 11:06 am urine source: kidney. **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml. . 6:00 am blood culture **final report ** blood culture, routine (final ): enterococcus faecium. final sensitivities. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: resistant to 1000mcg/ml of streptomycin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. daptomycin = 3mcg/ml, sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml enterococcus faecium | ampicillin------------ =>32 r daptomycin------------ s linezolid------------- 2 s penicillin g---------- =>64 r vancomycin------------ =>32 r anaerobic bottle gram stain (final ): gram positive cocci. in pairs and chains. . 3:18 pm urine source: catheter. **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml. . 6:00 am blood culture source: line-vip. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. sensitivities performed on request. staphylococcus, coagulase negative. 2nd strain. sensitivities performed on request. anaerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. . imaging: chest (pa & lat) ecg: sinus rhythm. low precordial lead voltage. compared to the previous tracing of the precordial voltage is diminished. otherwise, no diagnostic interim change. brief hospital course: 60f with esld hcv and mtx for psoaritic arthritis who presented initially for arf then developed a uti which was treated. the renal failure persisted consistent with hrs and she was started on hd. she then developed coag neg staph bacteremia and ?vre bacteremia versus contaminated bcx. of note, she has severe skin break down unknown etiology (?psorasis and cirrhotic edema and chronic steroid use). she had completed treatment for bacteremia with vancomycin but the bacteremia with coag neg staph recurred almost as soon as the vancomycin was stopped. she was againe treated with vancomycin for this. she did poorly clinically with severe skin breakdown, ongoing recurrent infections, and encephalopathy. she has been de-listed for liver trasnplant. after long discussion on with patient and family, it has been agreed that there the goals of care will be palliation. she continues to suffer from skin breakdown and hemorrhage. . #. goals of care: given inability to treat her infections skin breakdown and severe bleeding from heparin at hd, as well as the reality that will never be eligible for liver or kidney , she and here family agreed to comfort care. . #. anemia / bleeding: pt with ongoing bleeding from skin with minor trauma. she continues to lose blood at hd from heparinization. she has required 1-2u prcb per hd session for seepage from her multiple wounds. previously got epogen at hd. less bleeding on exam and off heparin for hd. transfusions discontinued given focus on comfort. continue multivitamins. . #. skin breakdown: she has a large hemorrhagic bulla at the site of her hd cath. she has two bullae on her legs bilaterally for which she was recently hospitalized, which are much improved now. she has skin tears on both arms and her back. she continues to have extensive skin breakdown of unknown etilogy but presumed to be from edema and psorasis. it seems likely that her skin breakdown is etiologic to her recurrent bacteremia. discontinued triamcinolone as psoriasis does not seem to be an active issue. minimized dressing changes and adhesives. per derm, cover entire skin surface with hydrated petrolatum for barrier protection and enhanced moisturization. per derm, apply bactroban to erosions daily and cover with adaptic dressings. continue multivitamins. was vitamin a def, which was repleted. . # bacteremia: bcx positive coag neg staph starting on for which she was initially on vancomycin. then developed vre bacteremia x1 bcx and was switched to daptomycin on . id felt this was a contaminant and dced her daptomycin. she completed treatment for coag neg staph bacteremia on with vancomycin. however a screening bcx from her hd line taken on again grew gpcs. her skin fragility/breakdown seems like the most likely source for her recurrent bacteremia. there is always the possibility that her multiple line placements recently played a role (s/p picc, hd attempt at beside, and hd line at ir). the picc and hd lines were both pulled and the hd line was replaced at ir. in addition, urine cx from grew esbl ecoli, pan-sensitive klebsiella, and mdr pseudomonas. she had initially been treated with unasyn, then aztreonam but changed to meropenem once cultures grew out. she developed a drug reaction with eosinophilia to meropenem, which was then dced. repeat ua was positive only for yeast x 2. appreciate prior id consult. repeat ucx with yeast only so dc'd foley as only small amount of urine produced. discontinued bactrim pcp sbp per comfort measures. continue rifaximin for bowel decontamination. bcx from hd line on grew coag neg staph in bottles. restarted vancomycin and pulled line on . new line was placed on by ir. subsequent cultures negative. status post 7 day course of treatment with vanco from . pus noted on r forearm . culture growing yeast. holding treatment for comfort measures. no further antibiotics planned. . #. acute on chronic kidney injury: patient's baseline cr pta was 1.8-1.9. she now seems to have hrs. her cr did no respond to increasing doses of octreotide, midorine, and albumin and she was unable to manage her volume status with a cr around 3. she was ultimately started on hd for respiratory distress hypervolemia. she is now essentially anuric. discontinued octreotide once on hd to preserve skin integrity. discontinued midodrine as hypertensive. discontinued albumin as ineffective. goals of care are palliative at this point, discontinuing hd for ongoing severe hemorrhage from heparin from lines. . #. encephalopathy: ongoing hepatic encephalopathy likely complicated by delirium. continue lactulose and rifaximin with goal to keep patient lucid, may refuse if she wants. . # respiratory distress: patient transferred to icu with respiratory distress on , thought to be volume overload. her respiratory symptoms improved with initiation of hd. . #. hcv and mtx cirrhosis: meld rising now that on hd, but not a candidate for give poor clinical status and risks of surgery and immune suppression in this patient. continue management of hepatic encephalopathy as above. discontinued bactrim given focus on comfort. . #. type ii diabetes mellitus: lantus only with qam fingersticks. . icu course: was transferred to the micu on hod 11 () for worsening respiratory distress and fatigue with tachypnea to 30's, hypoxemia requiring 4l nc (previously on ra). cxr c/w volume overload and team requesting icu transfer. the patient received 2u prbcs and it was thought that fluid overload and renal failure played a role in the respiratory distress. the patient pulled out her picc line, so ir placed a vip port. lactulose was started with good effect of large bms. blood cultures were positive for vre and the patient was started on daptomycin. she received hemodialysis on hod 12 (). was transferred back to the floor after o2 supplementation was weaned to room air. medications on admission: rifaximin 400 mg tid metoclopramide 5 mg tid prochlorperazine maleate 5 mg q6h prn for nausea triamcinolone acetonide 0.1 % cream famotidine 20 mg daily lactulose 30 ml qid glargine insulin 20 u daily riss albuterol nebulizations q4h prn ascorbic acid 500 mg zinc sulfate 220 mg daily bacrim ss daily midodrine 5 mg tid discharge medications: 1. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 2. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 3. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 4. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po tid (3 times a day). 5. mupirocin calcium 2 % cream sig: one (1) appl topical daily (daily): to erosions on chest, legs, and arms daily and cover with telfa gauze and tegaderm. 6. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. thrombin (bovine) 5,000 unit recon soln sig: one (1) recon soln topical prn (as needed): apply to bleeding areas for hemostasis. 9. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 13. morphine 10 mg/5 ml solution sig: 5-10 mg po q2h (every 2 hours) as needed. 14. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 15. simethicone 80 mg tablet, chewable sig: tablet, chewables po bid (2 times a day) as needed for gas. 16. insulin glargine 100 unit/ml solution sig: five (5) units subcutaneous at bedtime. discharge disposition: extended care facility: nursing and rehabilitation center discharge diagnosis: primary diagnosis: urinary tract infection, recurrent bacteremia, hepatorenal syndrome, cirrhosis, hepatic encephalopathy . secondary diagnosis: diabetes, depression discharge condition: stable vital signs, tolerating pos, alert and oriented x 2, poor skin integrity discharge instructions: it has been a pleasure taking care of you at . . you were admitted for renal failure and a urinary tract infection. you ultimately needed to start dialysis for your renal failure. your hospital course was complicated by multiple infections attributed to your skin problems. dermatology consulted on your skin problems but despite our best efforts you continue to have skin breakdown. you have had several infections of your blood which have been treated with antibiotics. because of your ongoing bleeding we cannot continue with dialysis. . at this point the goal of your care is comfort. given that, you have the right to refuse any treatments we offer. we have thinned your medication list to those things which will make your life more comfortable. followup instructions: none procedure: enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous abdominal drainage diagnoses: anemia of other chronic disease urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site cirrhosis of liver without mention of alcohol chronic hepatitis c with hepatic coma acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic kidney disease, unspecified bacteremia diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin other psoriasis chronic diastolic heart failure pseudomonas infection in conditions classified elsewhere and of unspecified site multiple and unspecified open wound of upper limb, without mention of complication other respiratory abnormalities other acquired deformities of ankle and foot other specified disorders of skin other accidents nontoxic uninodular goiter multiple and unspecified open wound of lower limb, without mention of complication 

Answer: The patient is high likely exposed to