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 62 year old white female with a history of congestive heart failure, pulmonary hypertension, type 2 diabetes mellitus, end-stage renal disease on hemodialysis, copd, history of mrsa bacteremia who was seen in the office for a left plantar ulcer. this area had been incised and drained a year earlier on , by dr. , podiatry. the patient underwent an outpatient arteriogram and then was scheduled for an elective revascularization of her left leg. past medical history: 1. congestive heart failure, with ventricular hypertrophy. pulmonary hypertension; ejection fraction 75%. 2. type 2 diabetes mellitus times 16 years, on insulin approximately five years. 3. end-stage renal disease on hemodialysis q. monday, wednesday and friday since . 4. mrsa bacteremia during hospitalization at . 5. chronic obstructive pulmonary disease. 6. pneumonia, hospitalization. 7. morbid obesity. 8. peripheral vascular disease. past surgical history: 1. multiple right foot ulcer debridements at hospital in . 2. left av fistula placed on , at hospital. 3. quinton catheter removal secondary to line sepsis during hospitalization at . 4. guillotine amputation of right foot on . 5. incision and drainage of right guillotine amputation on . 6. right below the knee amputation on . 7. incision and drainage with primary closure of wound by podiatry on . family history: noncontributory. social history: the patient lives with her husband. she uses a right limb prosthesis for ambulation. she quit smoking cigarettes 14 years ago. she does not use alcohol. allergies: penicillin, sulfa, ceftazidime, vancomycin, all cause a rash. clindamycin causes hives. codeine causes an unknown reaction. physical examination: vital signs, blood pressure 95/51; pulse 87. height 5'2"; weight 190 pounds. general: alert, cooperative, white female in no acute distress. heent: normocephalic, sclerae anicteric. neck: range of motion within normal limits. no lymphadenopathy or thyromegaly. carotids palpable. no bruits. chest: regular rate and rhythm without murmur. distant heart sounds. lungs are clear bilaterally. abdomen: obese. soft, nontender. extremities: right below the knee amputation well healed. there is hyperpigmentation in lipodermal sclerosis of the left leg from the knee to the foot. there is dependent rubor of the left foot. a 3.0 cm by 1.0 cm ulcer is present on the mid-portion of her left plantar foot. it is clean, without infection, but minimum granulation tissue is present. the patient had no palpable popliteal or pedal pulses. femoral pulses were not palpable due to obesity. neurological examination was nonfocal. laboratory: admission labs were white blood cell count 10.2, hemoglobin 10.8, hematocrit 37.0, platelets 160,000. sodium 140. potassium 4.8, chloride 101, co2 27, bun 39, creatinine 7.3, glucose 73. electrocardiogram on , showed a normal sinus rhythm at 94. no acute ischemic changes were present. chest x-ray done on , showed bilateral atelectasis or scarring at the bases. no congestive heart failure. right internal jugular catheter present. admitting medications: 1. levaquin q. day. 2. neurontin 100 mg p.o. twice a day. 3. niferex 1 capsule p.o. q. day. 4. zantac 150 mg p.o. q. day. 5. renagel. 6. amphojel. 7. percocet one tablet p.o. p.r.n. pain. 8. nph insulin 40 units subcutaneously q a.m. 9. nph insulin 12 units subcutaneously q. p.m. hospital course: the patient was admitted to the hospital on , following an uneventful left common femoral artery to above the knee popliteal bypass graft with dacron. at the end of surgery, the patient had a warm left foot with a doppler-able graft signal and a doppler-able dorsalis pedis signal. the patient's postoperative course was initially uneventful. postoperative pain was managed with an epidural until postoperative day number two when the epidural was discontinued and the pain was managed with percocet. the patient continued on her usual scheduled of hemodialysis q. monday, wednesday and friday. the patient's left leg incision was clean, dry and intact. her left plantar ulcer was clean. she had a felted foam dressing applied by the podiatry service on . normal saline dressings wet-to-dry twice a day for the plantar ulcer were ordered. physical therapy assessed the patient's mobility on , when the patient's right limb prosthesis was available. the patient was felt to be safe for discharge home by physical therapy with home physical therapy. the patient was at her baseline activity level. she was scheduled for a discharge home on . on the evening of , the patient developed a temperature spike to 101.6 f. her white blood cells were found to have risen to 16.1. her urinalysis was positive for white cells and red blood cells and cultures of her left medial thigh were taken. the patient also was confused and extremely sleepy, although easily arousable. infectious disease was consulted regarding the patient's temperature spike, indurated left medial thigh and multiple antibiotic allergies. infectious disease noted that the patient was extremely lethargic although arousable with a sternal rub. on physical examination, they found the left groin was well healed with some erythema along the incision and minimal tenderness. the right proximal knee of the below the knee amputation stump had some proximal tenderness and induration also. left ptosis was noted as well as some sudden jerking motions of the extremities. a head ct scan was negative. infectious disease recommended starting the patient on vancomycin because her only reaction to vancomycin in the past had been a rash. infectious disease also recommended a neurology consult and possible lumbar puncture. neurology saw the patient on . the only neurological findings were pinpoint pupils, which were reactive. this was thought to be due either to opioids versus diabetic sympathetic dysfunction. lumbar puncture done that day was within normal limits. on , the patient's left thigh wound with necrotic fatty tissue was debrided. the following morning, the patient had another temperature spike to 101.6 f. blood cultures were done. white count was down from 16,000 to 12,500. a pulsating mass was found in her left groin which indicated graft infection. cultures of the left groin grew klebsiella pneumoniae which was sensitive imipenem, zosyn, and bactrim. triaphen and flagyl was added to the patient's vancomycin therapy. the patient went to the operating room on , for removal of her infected left graft, vein patch angioplasty times two, and debridement of her wound. - drains were placed. tissue cultures were sent. a vac dressing was placed on the wound. postoperatively, the patient developed some hypotension in the recovery room and had to be placed on low-dose neo-synephrine infusion for blood pressure support. the patient's white blood cell count went up to 20,000. her groin cultures showed the that klebsiella was resistant to trianam. there was also moderate mrsa present in the wound. infectious disease recommended starting imipenem instead of the rianame, continuing the vancomycin and stopping the flagyl. the patient continued on her intravenous antibiotics with close monitoring by the infectious disease service. the patient developed ischemic rest pain of her left foot. her left leg wounds were stable. she also developed a new left heel ulceration. on , the patient had an episode from bleeding from her left leg wound. this resolved and she appeared stable, however, approximately six to eight hours later, the patient suddenly had a rupture of her graft and required an emergency revision angioplasty of her graft. postoperatively, the patient had a cool left leg without any doppler signal at the dorsalis pedis. on , after demarcation, the patient underwent a left above the knee amputation. on , the patient had a temperature spike of 101.1 f. her chest x-ray showed no pneumonia, only right scarring of base. her c. difficile cultures were negative. blood cultures were negative as well. urine cultures showed 105 enterococcus which infectious disease did not believe was clinically significant. the groin wound was treated with 1/4 strength betadine three times a day. the wound became cleaner but still had a lot of lymph drainage. a vac was started again on , and is changed every three to four days. on , the patient's left stump became dusky. over the course of several days, the incision was intact at the stump but became necrotic. no surgical revascularization was possible per dr. . dr. and the family met on , and were in agreement that no further surgery should be done at this time. pain control was very difficult to manage because of extreme sedation. pain service was consulted and at various times used fentanyl, pca, oxy-contin, dilaudid, percocet, and neurontin in various combinations for pain control. the patient became extremely agitated and confused, not recognizing her family, and all narcotics were stopped. the patient was given two tylenol for pain control and her mental status improved to baseline, but pain became a problem again. renal service recommended starting ultram 50 mg p.o. three times a day p.r.n. for pain on . as of this dictation, this regimen appears to keep the patient's pain under control. the renal service followed the patient for her usual hemodialysis schedule. they adjusted her medication with her history of hypophosphatemia and history in the past of hypercalcemia. through , the diabetes service was consulted to manage the patient's blood sugars and insulin requirements. the patient's appetite was extremely poor and p.o. intake was poor as well. calorie counts are in progress. her insulin doses will be adjusted according to her calorie intake. on , the patient was noted to have bright red blood per rectum as well as guaiac positive stools. external hemorrhoids were noted. follow-up guaiac of stool was negative. the patient's zantac was discontinued and protonix started. protonix was not tolerated by the patient and prevacid elixir was ordered instead. the patient required multiple transfusions for hematocrits less than 25. her most recent hematocrit on , was 28.2. at the time of dictation, the patient is alert, oriented to self and family. she is aware that she is in the hospital and that the year is . her left groin wound is clean and will continue to have q. three day vac dressing changes. her stump incision is intact and dry, but gangrenous along the entire length. the patient is being screened for a rehabilitation facility where hemodialysis can be done on site. at the time of dictation, the patient has been accepted to and is awaiting a bed. discharge medications: 1. vancomycin 1 gram intravenous, dosed for a random vancomycin level of less than 15; last dose scheduled for . 2. meropenem 500 mg intravenous q. 24 hours to be given after dialysis on dialysis days; last dose scheduled for . 3. flagyl 500 mg p.o. three times a day. 4. neurontin 100 mg p.o. twice a day. 5. ibuprofen 600 mg p.o. p.r.n. 6. nephrocaps one p.o. q. day. 7. prevacid elixir 30 mg p.o. q. day. 8. heparin 5000 units subcutaneously twice a day. 9. colace 100 mg p.o. twice a day. 10. niferex 150 mg p.o. q. day. 11. dulcolax suppository per rectum q. day p.r.n. 12. epogen units subcutaneously q. monday, wednesday and friday at hemodialysis. 13. nph insulin 10 units subcutaneously q. a.m. 14. humalog sliding scale at breakfast and at bedtime. condition on discharge: stable. disposition: rehabilitation facility. discharge diagnoses: ischemic, infected left leg. status post left above the knee amputation on . secondary diagnoses: 1. klebsiella methicillin resistant staphylococcus aureus infection of left leg. 2. methicillin resistant staphylococcus aureus urinary tract infection. 3. end-stage renal disease on hemodialysis. 4. diabetes mellitus. 5. blood loss anemia, status post multiple transfusions. 6. guaiac positive stool on , no recurrence. 7. sensitivity to narcotics. , m.d. dictated by: medquist36 procedure: other revision of vascular procedure other (peripheral) vascular shunt or bypass other skin graft to other sites graft of muscle or fascia excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn amputation above knee repair of blood vessel with unspecified type of patch graft repair of entropion or ectropion with wedge resection revision of amputation stump diagnoses: congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hemorrhage complicating a procedure infection and inflammatory reaction due to other vascular device, implant, and graft septicemia due to escherichia coli [e. coli] gangrene atherosclerosis of native arteries of the extremities with ulceration infection (chronic) of amputation stump diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to