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: iron attending: chief complaint: bacteremia major surgical or invasive procedure: - aortic valve replacement with #23mm st. mechanical valve/mitral valve replacement with #29mm st. mechanical valve and pericardial patch closure of aortic valve annular abscess. - peritoneal dialysis catheter - any questions call dr. ( history of present illness: mr. is a 47 year old male with end stage renal disease secondary to hypertension, who was admitted to with an infected right groin hemodialysis line on . he has had multiple access procedures, and the most recent hemodialysis line was placed approximately two months ago by av care. due to his known central stenosis, a groin site was chosen. for approximately one week, he has been having yellow discharge around the catheter. he had hd on friday, at which time he had a temperature of 101 and yellow discharge. upon admission to , blood and wound cultures were obtained, which grew staph aureus. he was started on vancomycin, and the catheter was removed. he was transferred to with bacteremia from infected hemodialysis line for continued management. past medical history: endocarditis, mitral regurgitation, hypertension, asthma, anemia, restless leg syndrome, esrd/hd, gastric esophageal reflux disease, multiple av grafts bilateral upper extremities, bilateral nephrectomies for renal carcinoma, s/p bilateral parathyroidectomy social history: currently incarcerated. history of cocaine use. no alcohol or tobacco family history: non-contributory. physical exam: vitals: t 98.1, hr 81 a-fib, bp 100/62, rr 20, o2 94ra gen: awake/alert/oriented, no acute distress cv: iregular rate and rhythm, no murmur resp: cta bilaterally, decreased in bases abd: soft, nt, nd, +bs extr: av grafts bilateral upper extremities, thrombosed; palpable radial and pt/dp pulses; left groin catheter site clean/dry/intact, no erythema/induration pertinent results: inr 2.5 130 90 26 -----------<116 4.4 23 1.3 &#8710; mg: 2.2 p: 2.7 echocardiography report echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 40% to 50% >= 55% findings left atrium: mild la enlargement. no spontaneous echo contrast is seen in the laa. right atrium/interatrial septum: normal ra size. a catheter or pacing wire is seen in the ra and extending into the rv. pfo is present. left ventricle: normal lv thickness and cavity size. right ventricle: normal rv free thickness. mildly dilated rv cavity. mild global rv free hypokinesis. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: three aortic valve leaflets. aortic root abscess. no as. trace ar. mitral valve: severely thickened/deformed mitral valve leaflets. large vegetation on mitral valve. abscess cavity adjacent to mitral valve. no ms. moderate to severe (3+) mr. tricuspid valve: mild to moderate +] tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: very small pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the patient received antibiotic prophylaxis. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. patient. regional left ventricular motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-cpb:1. the left atrium is mildly dilated. no spontaneous echo contrast is seen in the left atrial appendage. 2. a patent foramen ovale is present. 3. left ventricular thicknesses and cavity size are normal. 4. the right ventricular free thickness is normal. the right ventricular cavity is mildly dilated with mild global free hypokinesis. 5. there are three aortic valve leaflets. an aortic annular abscess is seen. there is no aortic valve stenosis. trace aortic regurgitation is seen. 6. the mitral valve leaflets are severely thickened/deformed. there is a large vegetation on the mitral valve. there is an abscess cavity seen adjacent to the mitral valve. moderate to severe (3+) mitral regurgitation is seen. there is a perforation seen of the anterior leaflet. 7. there is a very small pericardial effusion. dr. was notified in person of the results. post-cpb: on infusion of epi, levo, vasopressin. av pacing, then sinus rhythm. well-seated mechanical valve in the mitral position with normal washing jets seen. aortic valve is poorly seen in the deep transgastric view. there is a small transvalvular gradien of 15 mmhg. there is an eccentric paravalvuklar leak that originates near the anterior mitral leaflet side of the aortic annulus. the jet is mild to moderate. the lvef is now 40% with inferior hypokinesis. the rv is severely hypokinetic and dilated. there is 2+ tr. the aortic contour is normal post decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, on 13:17 chest ct scan a right lower lobe, air-fluid level containing, abscess is unchanged, again 22 x 22mm. note is also made of bilateral pleural effusions with overlying atelectasis/consolidation. ground-glass opacities, such as that in the right upper (4:56) are new, likely areas of developing infection/inflammation. note is made of pericardial fluid, similar to . mediastinal gas has resolved. a substernal hematoma is unchanged from . appearance of a splenic infarct is unchanged. patient is status post bilateral nephrectomies, aortic and mitral valve replacements. a right picc traverses a right brachiocephalic vein stent. extensive osseous sclerosis is unchanged, consistent with renal osteodystrophy. dr. wet read entered: mon 10:04 pm brief hospital course: mr. was transferred from to the transplant surgery service at on . he is a 47 year old male with end stage renal disease secondary to hypertension, who was admitted to with an infected right groin hemodialysis line on . he has had multiple access procedures, and the most recent hemodialysis line was placed approximately 2 months ago by av care. due to his known central stenosis, a groin site was chosen. for approximately 1 week prior to admission to he had been having yellow discharge around the catheter. he had hemodialysis on friday, at which time he had a temperature of 101 and yellow discharge. upon admission to , blood and wound cultures were obtained, which grew staph aureus. he was started on vancomycin, and the catheter was removed. he was transferred to with bacteremia from an infected hemodialysis line for continued management. he was on the surgical floors for several days when he became septic and hypotensive requiring pressors and a transfer to the surgical intensive care unit. an echo revealed severe mitral regurgitation with large vegetations. a transesophageal echocardiogram also revealed an aortic annular abscess. infectious disease was consulted. cardiac surgery was consulted and the usual pre-operative evaluation was initiated. on he became hypoxic and was intubated. later that day he was brought emergently to the operating room for aortic and mitral valve replacements with dr , please see operative report for details. in summary he had: 1. emergent mitral valve replacement with a 29-mm st. mechanical valve, reference number . 2. aortic valve replacement with a st. mechanical valve, reference number . pericardial patch closure of aortic valve annular abscess. his cardiopulmonary bypass time was 159 minutes with a crossclamp time of 134 minutes. he tolerated the operation and post-operatively was transferred to the cardiac surgery icu on vasopressin, epinephrine, levophed, and propofol infusions. cvvhd was initiated on the day of surgery. he was labile and hypoxic in the immediate post-op period and was kept sedated. additionally with any weaning of sedation he would become profoundly agitated and vacillated between hypotension and hypertension requiring resedation. he was also having episodes of atrial fibrillation which was initially treated with amiodarone that lead to bradycardia and discontinuation of the amiodarone. electrophysiology was consulted and they advised the avoidance of amiodarone. patient returned to sinus rhythm for a period and then went back into a-fib, he was eventually started on amiodarone without difficulty and his betablockers were increaed for desired effect. he presently is in rate controlled a-fib with stable hemodynamics on amiodarone taper. his valve cultures grew mrsa and he was given gentamicin and vancomycin. he was placed on cefepime for ventilator associated pneumonia. he developed vre bacteremia and enterocus pneumonia in the postop period and required several mores days of pressor therapy. . he was initially extubated a few days after his initial surgery but was reintubated for respiratory distress. he was hemodynamically unstable with rising lfts and lactic acid, work-up revealed, percardial hematoma causing tampanade and was brought back to the or on pod#6 for evacutaion. he returned with improved hemodynamics. he remained intubated for several more days afterwards, due to hypoxia due to fluid overload and agitation. he was again extubated on and has continued to do well. he required cvvh therapy and was transitioned to hd. he contined to have access issues post-op, left avf remained clotted, and on pod#18 he had a left groin tunnelled hd cath placed as well as a right picc. his amylase and lipase spiked in the post-op period which was felt to be chemicially induced, his diet was advanced and they have been trending down slowly. his antibiotics were adjusted per id, he was switched to cefepime and daptomycin, he was positive for c-diff and started on po vanco () a chest ct done o as part of his work-up for line placement revealed rll abscess.a repeat chest ct was obtain prior to discharge and it showed an unchnaged abcess (see reports. his longterm dialysis plan is to do peritoneal dialysis, therefore a pd cath was placed (catheter can be used after 3 weeks). the plan is to continue with hd until all antibiotics are dc'd (on id will determine this), afterwhich his pd can be initiated. id has requested that his lines be minimized prior to discharge, therefore his antibiotics were chanaged to accomadate this plan. he was swithced to iv vanco three times a week after dialysis to be infused through his hd line and cefepime was changed to cipro on day of discharge and he continues on oral vanco for c-diff. all antibiotics are to be discontinued on after his id appointment on that day. he will need his peritoneal dialysis cath flushed and dressing changed per policy. heparin was started for his double mechanical valve and his inr is currently (2.5) therapeutic off heparin his inr goal is 2.5-3.5 . mr remains in custody but has continued to progress and has been deemed safe to be discharged in , ma on rt 57 for further strengthening, conditioning and medical management po amiodarone started on for post-op a-fib ***he has an anti-c antibody which could lead to a delayed transfusion reaction in the future.*** medications on admission: meds on transfer: ventolin 60mg daily, asa 81mg daily, sinemet 25/250 2 tabs qhs, benadryl 25mg tid, colace 100mg , labetalol 300mg , sevelamer 4000mg tid, vancomycin 1g daily, verapamil 480mg daily discharge medications: 1. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 5. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qfri (every friday). 6. carbidopa-levodopa 25-250 mg tablet sig: one (1) tablet po hs (at bedtime). 7. heparin (porcine) 1,000 unit/ml solution sig: 3000-10,000 unit dwell injection daily (daily). 8. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 9. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 10. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 12. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 13. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): decrease to 400mg daily on then decrease to 200mg daily ongoing on . 14. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours). 15. guaifenesin 600 mg tablet extended release sig: two (2) tablet extended release po bid (2 times a day). 16. vancomycin 250 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 1 days: last dose mid night . 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for dyspnea. 18. warfarin 7.5 mg tablet sig: one (1) tablet po once a day: goal inr 2.5-3.5 for mechcanical mvr/avr if inr falls below 2.5- needs iv heparin until inr >2.5. 19. outpatient lab work check inr daily for one week then 3 times weekly then mon/wed/fri for 2 weeks until on stable coumadin dose with stable inr then at least monthly maintenance. 20. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gm intravenous hd protocol (hd protochol): dose through - and duration will be determined at id follow up . 21. line flushes tunneled access line (e.g. hickman), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 22. cipro 500 mg tablet sig: one (1) tablet po once a day: duration will be determined at follow up appointment with infectious disease. 23. oxycodone 5 mg capsule sig: one (1) capsule po q4hrs as needed for pain. disp:*65 capsule(s)* refills:*0* 24. ativan 0.5 mg tablet sig: one (1) tablet po q6hrs as needed for anxiety. disp:*60 tablet(s)* refills:*0* 25. peritoneal dialysis catheter flushes per protocol peritoneal dialysis catheter placed- any questions call dr. ( discharge disposition: extended care facility: - discharge diagnosis: s/p aortic valve replacement with #23mm st. mechanical valve/mitral valve replacement with #29mm st. mechanical valve and pericardial patch closure of aortic valve annular abscess. reoperation for evacuation of mediastinal hematoma pmh: endocarditis, mitral regurgitation, hypertension, end stage renal disease/hemodialysis x16 years secondary to hypertensive nephropathy- asthma, anemia, restless leg syndrome, gastric esophageal reflux disease, s/p bilateral nephrectomies for renal carcinoma, s/p bilateral parathyroidectomy, s/p multiple aortovenous graft placements- bilateral upper extremities discharge condition: alert and oriented x3 nonfocal ambulating with assist incisional pain managed with tylenol sensitive to narcotics incisions: sternal - healing well, no erythema or drainage healing well, no erythema or drainage. stage 3 decubitus wound extremities: lower extremities: 1+ edema; + left upper extremity discharge instructions: 1) after your dialysis catheter in your groin is removed: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage 2) please no lotions, cream, powder, or ointments to incisions 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart 4) no lifting more than 10 pounds for 10 weeks 5) please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. date/time: 1:00 medical building cardiologist: dr. phone: date/time: 1:20 infectious disease dr. at 10:30am in medical office building basement bsoton ma - peritoneal dialysis catheter - any questions call dr. ( procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis open and other replacement of aortic valve open and other replacement of mitral valve closed [endoscopic] biopsy of bronchus pericardiotomy operations on other structures adjacent to valves of heart creation of cutaneoperitoneal fistula central venous catheter placement with guidance diagnoses: other iatrogenic hypotension end stage renal disease severe sepsis cardiac complications, not elsewhere classified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure acute respiratory failure atrioventricular block, complete cardiogenic shock intestinal infection due to clostridium difficile abscess of lung pressure ulcer, lower back acute and subacute bacterial endocarditis kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other and unspecified infection due to central venous catheter personal history of malignant neoplasm of kidney acquired absence of kidney methicillin resistant staphylococcus aureus septicemia acute pericarditis, unspecified pressure ulcer, stage iii cardiac tamponade pneumonia due to other streptococcus 

Answer: The patient is high likely exposed to