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: tetracycline analogues attending: chief complaint: unable to void major surgical or invasive procedure: foley catheter changed history of present illness: mr. is a 66 year old man with juvenile rheumatoid arthritis and an indwelling foley catheter secondary to an atonic bladder. he presented to the ed today with a one day history of inability to void and abdominal pain. he states that he uses a leg bag during the day and a larger bag at night, which are emptied by his two pcas (each comes for 2 hours a day, morning and evening). he is not aware of any abnormal-appearing urine recently and has not had dysuria. he also reports that to his knowledge his leg ulcer is at baseline, not getting worse. . in the ed, initial vs were: 97.8 103 136/79 18 100%. his foley was exchanged and drained 1 l of purulent-looking urine. this resolved his abdominal pain. he had very poor access, so labs were not able to be obtained. he had an intraosseous line placed in the right lower extremity and was given il of iv fluids. while in the ed, he was noted to be hypotensive to sbp 40s-50s/p; however, his small arms and body habitus made a good difficult. bp in the leg was 90s/40s, and his mental status was clear throughout. his left lateral ankle was also noted to be malodorous. he received vancomycin (for leg cellulitis) and zosyn for antibiotics. . on the floor, patient reported complete resolution of abdominal pain. he reported discomfort at the io site, as well as his chronic hip and knee pain because he did not receive home pain meds in ed. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - with chronic indwelling foley catheter - juveile rheumatoid arthritis (no steroids in decades, but history of chronic steroids x 15 years) - osteoporosis - gerd - left venous stasis ulcer, chronic - hemorroids - chronic pain of knee, back, shoulder, hip - s/p c. difficile infection - cellulitis/osteomyelitis of his calf - multiple orthopedic surgeries (no hardware per patient) to ankles, knees, neck, right elbow social history: former smoker, 10 pack years. rare alcohol. retired neurohistologist (formerly worked at ). lives alone in an apartment in , two pcas help him in the morning and evening. uses an electric wheelchair to get around both at home and outside his home. family history: brother died of colon cancer in his 40s. mother with alcoholism, cirrhosis, and heart attack. sister alive and well. father alive with hypertension. physical exam: physical exam on admission to vitals: t: bp: 121/67 p: 91 r: 18 o2: 96% on ra general: alert, oriented, no acute distress. small body habitus with foreshortened extremities and small hands and feet. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp difficult to assess given body habitus (large jowls), no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: small amount of purulent discharge at urethra, foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. superficial ulceration of left lower extremity with copious yellow exudative discharge and minimal surrounding erythema, slightly indurated. pertinent results: labs on admission: 04:20pm wbc-15.5*# rbc-3.53* hgb-6.9* hct-23.4* mcv-66* plt ct-385 neuts-83.8* lymphs-11.6* monos-3.8 eos-0.5 baso-0.3 pt-14.4* ptt-39.7* inr(pt)-1.2* glucose-112* urean-30* creat-0.8 na-140 k-4.1 cl-106 hco3-26 angap-12 calcium-7.7* phos-2.8 mg-1.9 urine color-yellow appear-cloudy sp -1.017 urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-lg urine rbc-30* wbc->182* bacteri-mod yeast-none epi-0 urine wbc clm-many mucous-many labs on discharge: 01:04pm wbc-10.6 rbc-3.27* hgb-6.4* hct-22.9* mcv-70* plt ct-337 glucose-113* urean-17 creat-0.6 na-139 k-4.1 cl-104 hco3-28 angap-11 imaging: - tib/fib x -ray: intraosseous catheter is seen with tip in the proximal tibial metadiaphysis beyond the cortical margin. bones are diffusely osteopenic with ankylosis involving the hindfoot, midfoot and ankle. extensive degeneration and distortion incompletely assessed at the knee. extensive vascular calcifications are also seen. impression: io catheter in the proximal tibia. microbiology: urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. work up per dr . . pseudomonas aeruginosa. >100,000 organisms/ml.. proteus mirabilis. 10,000-100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. enterococcus sp.. 10,000-100,000 organisms/ml.. ampicillin and penicillin sensitivity testing performed by sensititre. daptomycin sensitivity testing per dr #. daptomycin sensitivity testing performed by sensititre. sensitive to daptomycin (mic=1mcg/ml). sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | proteus mirabilis | | enterococcus sp. | | | ampicillin------------ =>32 r 1 s ampicillin/sulbactam-- =>32 r cefazolin------------- 16 i cefepime-------------- 8 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 2 i =>4 r daptomycin------------ s gentamicin------------ <=1 s 4 s linezolid------------- 2 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- <=16 s penicillin g---------- 4 s piperacillin/tazo----- <=4 s tetracycline---------- =>16 r tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r vancomycin------------ =>32 r brief hospital course: mr. is a 66 year old man with a history of jra and bladder atony with chronic indwelling foley who presents with one day of urinary retention and abdominal pain. # urinary tract infection. most likely urinary retention from clogged/obstructed foley catheter. foley catheter was changed on . last documented catheter change prior was in . upon admission to the icu, hemodynamics were stable with improvement of his abdominal discomfort. his outpatient urologist was informed. urine culture was significant for vre and psuedomonas, and the patient was placed on macrobid and meropenem initially, which was transitioned to macrobid and piperacillin-tazobactam at discharge. a picc was placed in the lue for home antibiotics, and he will complete a total of 14 days of antibiotics. safety labs to be sent on wednesday, and faxed to the id division. patient will susbsequently follow-up with his outpatient id physician .. patient remained afebrile, asymptomatic and hemodynamically stable throughout his stay on the general medicine service. # urinary retention. bladder atony with chronic indwelling foley. since the change of foley catheter on admit, his abdominal discomfort improved, suggesting possible clogging in the catheter. patient will have continued follow-up with his outpatient urologist. need scheduled foley catheter changes, (np) and dr. note on # chronic leg ulcer, pvd: baseline per patient. patient has been followed by dr. for his non-healing ulcer. asa 162mg was continued, and qod aquacel silver dressings were ordered. blood cultures remained negative. no antibiotics were given specifically for the wound infection. # hypotension. concerning for peri-sepsis initially, but apparently hypotension in the ed and borderline in the icu. unclear if this was due to poor cuff given his body habitus and use of a large cuff in the ed or if it recovered quickly after 1l of ivf. using pediatric cuff, readings remained mostly in the 110s. # microcytic anemia: history of iron-deficient anemia. no evidence of acute bleed. pt was continued on his home iron therapy. iron studies were normal. hct remained near his baseline during his admission. # osteoporosis: likely secondary to chronic steroid use. has chronic pain related to multiple surgeries. continued home actonel (mondays). continued methadone and oxycodone for chronic pain code status: ok to intubate, defibrillate or cardiovert; no chest compressions medications on admission: famotidine 40 mg qpm methadone 5 mg/5 ml solution, 10 ml by mouth at 6pm oxycodone 10 mg q4 hours risedronate 35 mg every week aspirin 162 mg daily ferrous gluconate 324 mg tid multivitamin discharge medications: 1. famotidine 20 mg tablet sig: two (2) tablet po hs (at bedtime). 2. methadone 10 mg/ml concentrate sig: one (1) po daily at 6 () as needed. 3. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 4. risedronate 35 mg tablet sig: one (1) tablet po weekly on monday () as needed for osteoporosis. 5. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 6. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po tid (3 times a day). 7. multivitamin tablet sig: one (1) tablet po once a day. 8. nitrofurantoin monohyd/m-cryst 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 17 doses. disp:*17 capsule(s)* refills:*0* 9. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) dose intravenous every six (6) hours for 8 days. disp:*8 day's supply* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: hypotension urinary tract infection-complicated atonic bladder with chronic foley l.leg chronic ulcer juvenile rheumatoid arthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were intially admitted with abdominal pain and inability of your foley catheter to drain. for this, you had your foley catheter replaced. you were given antibiotics for a urinary tract infection. you will need to take zosyn and macrobid upon discharge through . medication changes: 1. take zosyn and macrobid through please take all of your medications as prescribed and follow up with the appointments below. followup instructions: department: primary care name: dr. when: wednesday at 3:15 pm address: ,, , phone: department: infectious disease when: friday at 8:30 am with: , md building: lm campus: west best parking: garage department: vascular surgery when: wednesday at 11:30 am with: , np building: lm campus: west best parking: garage procedure: central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: other chronic pain anemia, unspecified urinary tract infection, site not specified peripheral vascular disease, unspecified personal history of tobacco use hypotension, unspecified cellulitis and abscess of leg, except foot atony of bladder osteoporosis, unspecified pressure ulcer, lower back streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypovolemia pseudomonas infection in conditions classified elsewhere and of unspecified site venous (peripheral) insufficiency, unspecified other specified retention of urine pressure ulcer, stage ii family history of malignant neoplasm of gastrointestinal tract polyarticular juvenile rheumatoid arthritis, chronic or unspecified ulcer of calf mechanical complication due to urethral (indwelling) catheter 

Answer: The patient is high likely exposed to