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 a 69 year old man with end stage renal disease on hemodialysis, status post a recent hospitalization for an arteriovenous graft clot and methicillin resistant staphylococcus aureus infection, requiring medical intensive care unit admission for increased oxygen requirements post graft removal, with evidence of septic pulmonary emboli, a negative transesophageal echocardiogram and negative bone scan. the patient had partial removal of arteriovenous graft; placement of a temporary quinton and placement of a tunneled catheter on . the patient was discharged to a nursing home on . the patient was initially treated while in house with oxacillin and changed to cefazolin with dialysis to facilitate dosing at the time of discharge. on presentation, the patient complained of shortness of breath, fevers, chills for the past one to two days with a cough, productive of sputum. there was no chest pain and no pleuritic pain. the patient did report orthopnea that was worsening. he does not walk at baseline. no nausea, vomiting, diarrhea, constipation, no melena, bright red blood per rectum, no lower extremity edema. chronic rash. examination was limited since the patient was on bi-pap and in mild respiratory distress. past medical history: 1. end stage renal disease on hemodialysis, monday, wednesday and friday. last dialysis . 2. diabetes. 3. congestive heart failure with an ejection fraction of 20%. 4. coronary artery disease, status post coronary artery bypass graft in . status post myocardial infarction in and . 5. history of atrial fibrillation. 6. anemia. 7. peripheral vascular disease. 8. status post cerebrovascular accident. 9. question of protein s deficiency. 10. kyrley's disease. 11. history of tonic/clonic seizure in the setting of sepsis. medications: 1. cefazolin one gram q. day with hemodialysis, through , to complete a four week course. 2. aspirin 325 mg p.o. q. day. 3. lopressor 25 mg twice a day. 4. captopril 12.5 three times a day. 5. amiodarone 200 mg q. day. 6. digoxin .125 mg q.o.d. 7. calcium acetate 667 mg p.o. three times a day q. a.c. 8. protonix 40 mg q. day. 9. lidoderm 5% patch 6 p.m. to 6 a.m. 10. subcutaneous heparin, 5000 units q. 8 hours. 11. vicodin 5/500 two tablets p.o. prn. 12. albuterol prn. 13. atrovent nebs q. six hours. 14. regular insulin sliding scale. 15. docusate sodium. social history: prior to last admission, the patient lived at home, ambulatory. he is a former security officer, retired. positive tobacco history, one pack per days times 52 years and current smoker. occasional alcohol. physical examination: temperature 101.5; heart rate 87; blood pressure 133/58; respirations 20; saturating 100% on a non rebreather. general: middle-aged male sitting in moderate respiratory distress. head, eyes, ears, nose and throat: normal cephalic, atraumatic. pupils are equal, round, and reactive to light and accommodation. neck supple. no lymphadenopathy. cardiovascular: tachycardiac. pulmonary positive for rhonchi with decreased air movement of the left mid and lower lobe. mild right lower lobe crackles. abdomen with ecchymosis, soft, nontender, nondistended. extremities: trace edema. right sided 1+ pulses. left sided pulses not palpable. neurologic: alert and oriented times three. cranial nerves 2 through 12 intact. moves all four extremities. decreased sensation in the feet. skin with necrotic lesions on the shins and chest. wound in the right upper extremity with yellow ooze, beefy base and sutures intact. laboratory data: white count 13.6 with 90 neutrophils, 5 lymphs, 5 monos. hematocrit of 32.9. platelets of 274. chemistries: 127, 7.2, 92, 22, 37, 4.2, 317. calcium of 1.01. magnesium of 1.4. phosphorus of 5.1. arterial blood gases revealed 7.46, 28, 100 on 100% non rebreather. lactate 4.4 down to 3.3. ck of 86. troponin of 0.19. ast 29. alt 19. alkaline phosphatase of 244. amylase of 34. total bilirubin of 0.5. lactase 8. albumin 2.8. urinalysis with large blood, 500 protein, 1000 glucose, negative ketones. greater than 50 red cells, greater than 50 white cells. occasional bacteria. 6 to 10 epis. prior ct from showed multiple peripheral nodules and opacities; some cavitated, consistent with septic emboli. chest x-ray showed a left mid lung with opacification and air bronchograms; possible small left effusion. stable congestive heart failure, consistent with chest x-ray from . electrocardiogram revealed tachycardia, irregular; old q in v1 and v3. j point elevation. new peak t waves. new t wave inversions in avl. hospital course: the patient was admitted and his hospital course was significant for the following issues: 1. sepsis: the patient was started on the sepsis protocol as he met criteria. he received ceftriaxone and vancomycin. the patient received therapy per the sepsis protocol. he was continued on ceftriaxone and vancomycin and was also started on oxacillin given his prior recent surgery and methicillin resistant staphylococcus aureus bacteremia. the patient had blood cultures which were negative to date at the time of this dictation. 2. pneumonia: the patient had a significant lingular pneumonia with a small left sided effusion. this effusion was deemed not to be large enough to consider thoracentesis. on , the patient became more tachypneic in the emergency room, with a question of mucus plugging. he was intubated for impending respiratory failure and copious secretions were obtained from the endotracheal tube. the patient was continued on ceftriaxone with clinical improvement. a sputum culture revealed 1+ gram negative rods, awaiting speciation at the time of this dictation. the patient was extubated on and remained afebrile on antibiotics. 3. history of bacteremia: the patient had been discharged on cefazolin with hemodialysis. on admission, he was restarted on oxacillin and vancomycin. since there was no evidence of methicillin resistant staphylococcus aureus infection, the vancomycin was discontinued. he was continued on oxacillin since that is better drug for a staph bacteremia. while this antibiotic regimen of oxacillin and ceftriaxone was felt to not be very elegant, given the fact that the patient had already completed three weeks of coverage for gram positive bacteremia, with a negative tee, the decision was made to continue him on oxacillin while in house to complete his four week course. transplant surgery team saw the patient in house and noted the surgical site in the left upper extremity was clean, dry and intact with no erythema or discharge on . there was no need for antibiotics. they recommended wet to dry twice a day dressings and will follow-up to discontinue the sutures. 4. pulmonary: as previously noted, the patient was intubated for impending respiratory failure with copious secretions. over the course of the next few days, his respiratory status continued to improve with a combination of antibiotics and hemodialysis to remove any pulmonary edema. he was extubated on without difficulty and, at the time of this dictation, he was oxygenating well on two liters nasal cannula. 5. congestive heart failure: the patient had some evidence of volume overload given his orthopnea. his jvp was flat; however, he was deemed to need close monitoring of fluids. his lopressor and ace inhibitor were initially held and later restarted. when the patient was stable, his ace inhibitor was titrated up for a greater afterload reduction and blood pressure control. the patient was also maintained on his digoxin. 6. rhythm: the patient was noted to be in atrial fibrillation. he was continued on beta blocker and amiodarone. at the time of this dictation, the patient was still in atrial fibrillation with good rate control. the patient was not on any anticoagulation. it is unclear why this was the case. 7. coronary artery disease: the patient has a history of myocardial infarction times two. the patient's enzymes were cycled and he was continued on telemetry. he was continued on aspirin. 8. end stage renal disease: hemodialysis fellow was informed. the patient had no acute indication for hemodialysis. he underwent dialysis on tuesday, and was scheduled to undergo dialysis on with removal of two to three liters of fluid. 9. endocrine: the patient was initially maintained on an insulin drip per protocol. he was transitioned to a regular insulin sliding scale after his sugars were noted to be in good control. 10. hematology: the patient's hematocrit was low. he continued epogen with dialysis and should be transfused with one unit with hemodialysis on , given his hematocrit of 29.1, in a patient with coronary artery disease. 11. gastrointestinal: the patient had some loose stool on . given the history of antibiotics, a culture was sent for clostridium difficile toxin and this was still pending at the time of this dictation. 12. fluids, electrolytes and nutrition: after extubation, the patient was started on a diabetic diet and was continued on calcium. 13. prophylaxis: the patient was continued on subcutaneous heparin and tpi. 14. code status: at the time of this dictation, the patient reports that he would not want to be reintubated. he would like to have full resuscitation in the event of a cardiac arrest. the patient was encouraged to discuss his code status with health care proxy and family members. seemed somewhat uncertain and said he might change his mind in the future but it was clear that he did not want to be intubated at this time. disposition: the patient had a physical therapy consult and was stable for transfer to the floor on . medications on transfer: 1. captopril 25 mg three times a day. 2. metoprolol 25 mg twice a day. 3. regular insulin sliding scale. 4. ceftriaxone one gram q. 24 hours. 5. oxacillin 2 grams intravenous q. six. 6. ipratropium nebs. 7. albuterol inhaler. 8. flovent. 9. bisacodyl. 10. senna. 11. docusate. 12. acetaminophen. 13. subcutaneous heparin. 14. calcium. 15. digoxin .125. 16. amiodarone 200 mg q. day. 17. aspirin 325. 18. lorazepam prn. discharge diagnoses: 1. gram negative lingular pneumonia. 2. history of bacteremia with methicillin resistant staphylococcus aureus. the rest of this dictation will be done by the medicine accepting team. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis thoracentesis closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure chronic systolic heart failure primary hypercoagulable state 

Answer: The patient is high likely exposed to