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: patient recorded as having no known allergies to drugs attending: chief complaint: right foot cellulitis major surgical or invasive procedure: right above the knee amputation gastrojejunostomy tube placement percutaneous tracheostomy multiple central line placements swan ganz catheter placement picc line placement lumbar puncture history of present illness: 72m h/o pvd who p/w worsening right foot ulcer & cellulitis to mid calf, as well of necrotic right 3rd-5th toes. he is 3 weeks s/p r hallux amputation for necrosis, from which his foot never completely healed & the necrotic process has progressed. he denies claudication or rest pain, but is wheelchair bound, and reports fevers at home despite treatment with keflex and augmentin. ros: +angina, no dyspnea, h/o cva with swallowing difficulties at home, +bph past medical history: pmh: 1.cad; h/o angina 2.s/p cva 3.type 2 dm, with retinopathy 4.hepatitis (shellfish) 's 5.bph 6.pvd 7.dementia psh: 1.aortobifemoral bpg by dr. 2. l great toe amp social history: pt lives with his wife. uses and wheelchair at home. smoking 1/2pk cigarettes per day x 50 years. he does not drink alcohol. family history: noncontributory. physical exam: t 98.6 p 70 bp 130/70 rr 20 02 98% ra wt 165 lbs alert, nad bilat carotid bruits, no jvd rrr 2/6 sem cta bilat soft nontender necrotic r toes, surrounding erythema to midcalf r knee flexion contracture, 1+ pedal edema (r>l) pulses (r/l): car , fem , /dp/pt no signals pertinent results: on presentation 08:25pm blood wbc-13.0* rbc-3.92* hgb-11.9* hct-33.3* mcv-85 mch-30.3 mchc-35.7* rdw-13.5 plt ct-314 08:25pm blood glucose-110* urean-11 creat-1.1 na-142 k-3.4 cl-104 hco3-26 angap-15 06:40am blood triglyc-132 hdl-38 chol/hd-3.5 ldlcalc-68 r foot swab: probable enterococcus. moderate growth. yeast. sparse growth. corynebacterium species (diphtheroids). sparse growth. inpatient cultures blood culture: coag negative staph (1/4 bottles) swabs: vre+, mrsa- sputum cx: pseudomonas sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- =>16 r meropenem------------- 8 i piperacillin---------- 16 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s urine cx: pseudomonas (>100k colonies) sensitivities: mic expressed in mcg/ml ______________________________________________________ pseudomonas aeruginosa | cefepime-------------- 16 i ceftazidime----------- 8 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- =>16 r meropenem------------- =>16 r piperacillin---------- 16 s piperacillin/tazo----- 64 s tobramycin------------ <=1 s 01:13pm blood cortsol-16.6 03:20pm blood cortsol-22.5* radiology tte: ef 45%. septal & apical hypokinesis and possible inferior hypokinesis. no ai/as, 1+ mr, 2+ tr, moderate pulm systolic htn. no vegetations. ct head: no acute stroke. chronic microvascular infarcts. ct chest: 1. new moderate to large bilateral pleural effusions and marked progression of bilateral consolidation. dependent distribution suggests aspiration pneumonia. 2. additional perihilar ground-glass opacity, in the setting of bilateral pleural effusions, consistent with pulmonary edema or ards. 3. two round, hypodense lesions in the right kidney are too small to accurately characterize but likely represent cysts. 4. prominence of the left adrenal gland without focal mass identified. 5. prostate enlargement. ct a/p: 1. interval improvement in bilateral perihilar ground glass opacities suggestive of interval improvement in pulmonary edema. there are persistent bilateral pleural effusions, which have increased in size since the prior study with bibasilar compressive atelectasis/consolidation. 2. small pericardial effusion. 3. small amount of ascites which has increased in the interval. 4. stable appearance of fullness in the left adrenal gland without a focal mass. 5. no focal fluid collections within the torso to suggest an abscess. 6. anasarca. picc placement, gj tube placement discharge labs 11:32pm blood type-art temp-36.4 rates-/28 peep-5 fio2-40 po2-159* pco2-33* ph-7.47* calhco3-25 base xs-1 intubat-intubated 03:18am blood wbc-12.9* rbc-3.03* hgb-9.4* hct-27.6* mcv-91 mch-30.9 mchc-34.0 rdw-18.2* plt ct-245 02:18am blood pt-14.3* ptt-26.0 inr(pt)-1.4 03:18am blood glucose-156* urean-13 creat-0.6 na-141 k-4.2 cl-110* hco3-23 angap-12 03:18am blood albumin-2.1* calcium-7.7* phos-4.0 mg-1.7 brief hospital course: admitted on with necrotic toes & cellulitis of his right lower leg. given rising ck levels, an amputation was unavoidable. after appropriate cardiac clearance, he was taken to or for a right above-the-knee amputation on (refer to op note for specifics). was cleared for po diet (thickened liquids) by swallow team on , but developed acute respiratory distress requiring intubation & transfer to icu setting on . an organ system-based synopsis of his prolonged icu course is summarized below. neuro: he was sedated with propofol & ativan while intubated, and was unresponsive until about 1 week prior to discharge. numerous head ct's were negative. at discharge, he responds to voice and is able to move all extremities, but does not follow commands. cv: because of his septic shock, he required significant pressor to maintain an adequate blood pressure (map>60). these were weaned off as his sepsis improved. he did develop cardiac enzyme leak around the time of his respiratory failure, but an echo did not show any significant loss of ventricular function. resp: respiratory event attributed to aspiration pneumonia, which worsened over next few days to fulminant ards & septic shock. improved over weeks in icu with broad spectrum antibiotics (empiric for presumed infection), xigris (for refractory septic shock) & ultimately steroids (for adrenal insufficiency). he was intubated on , and remained intubated throughout the remainder of his hospital stay. he was changed to a tracheostomy on , and gradually weaned down to pressure support ventilation. +pseudomonal pna 3 days prior to discharge, being treated with tobramycin & suctioning q1-2h prn. fen: currently about 15kg above his baseline weight of 75kg. being diuresed with lasix iv drip about kg/day. transitioned to pgt lasix prior to discharge & will continue diuresis to his baseline weight. gi: perc gj tube placed by interventional rediology with position confirmed with 11/10 kub. respalor tube feeds via gt at goal of 50cc/hr. last albumin 2.1. regular bms with bowel regimen of colace + prn laxatives. heme: required multiple transfusions for anemia of chronic disease (baseline hct 33). due to immobility, need to continue with sc heparin (or lovenox) and l foot p boots to prevent dvts. id: never had positive cultures from suspected aspiration pneumonia or for several weeks following respiratory event, despite almost daily cultures & multiple cvl changes. he was treated for 3 weeks with broad spectrum antiobiotics (linezolid, levaquin, meropenem, flagyl & fluc). after stopping antibiotics, his wbc & temperatures recurred & he developed copious diarrhea. all of these symptoms improved on flagyl, despite no positive stool cultures. his last temperature was on days prior to discharge. sputum & urine cultures from then grew out pseudomonas, and this is being treated with 2 weeks of tobramycin. given diuresis with lasix & tobramycin therapy, renal toxicity is a concern & his creatinine should be checked at least q48-72 hours. tobramycin levels should also be checked (with goal trough < 1 and peak ). any bump in his creatinine should prompt relaxation of the diuresis as well as complete discontinuation of the tobramycin, per our infectious disease team. endo: he was treated with insulin to maintain a blood glucose of 80-120. at the time of discharge, he was receiving standing doses of nph & regular insulin q6. the sliding scale is attached with the prescriptions. disp: full code, wife is hcp (cell ) medications on admission: 70/30 15u qam, zocor 40, enalapril 10, celexa 40, asa 81, lopressor 12.5, imdur 30, flomax 0.4, diltiazem cd 120, lasix 160, kcl 10meq' discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). disp:*90 ml* refills:*2* 2. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 1 weeks. disp:*21 tablet(s)* refills:*0* 3. lopressor 50 mg tablet sig: one (1) tablet po twice a day: hold for sbp<100, hr<60. disp:*60 tablet(s)* refills:*2* 4. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. disp:*1 inhaler* refills:*5* 6. nicotine 7 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*30 patch 24hr(s)* refills:*2* 7. lansoprazole 30 mg susp,delayed release for recon sig: one (1) dose po daily (daily). disp:*30 doses* refills:*2* 8. docusate sodium 150 mg/15 ml liquid sig: two (2) teaspoons po bid (2 times a day). disp:*120 teaspoons* refills:*2* 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. disp:*250 ml(s)* refills:*3* 10. ibuprofen 100 mg/5 ml suspension sig: six hundred (600) mg po q8h (every 8 hours) as needed for fever. disp:*3000 mg* refills:*2* 11. acetaminophen 160 mg/5 ml solution sig: one (1) teaspoon po every eight (8) hours as needed. disp:*30 teaspoon* refills:*0* 12. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). disp:*qs containers* refills:*2* 13. lorazepam 2 mg/ml syringe sig: 0.5-1 mg injection every six (6) hours as needed: hold for confusion, sedation. disp:*30 mg* refills:*2* 14. insulin sliding scale follow attached nph regimen & regular insulin sliding scale. goal fingersticks 80-120. 15. outpatient lab work twice weekly labs: cbc, chem-10 : tobramycin peak & trough levels 16. lasix 40 mg tablet sig: one (1) tablet po twice a day: continue until he approaches his baseline weight of 70kg. check regular labs to eval k & creatinine. disp:*30 tablet(s)* refills:*2* 17. potassium chloride 20 meq packet sig: two (2) packet po once a day: 40 meq qd while using lasix. hold for k > 4.6. disp:*30 packets* refills:*2* 18. tobramycin sulfate 10 mg/ml solution sig: one y (120) mg injection every twelve (12) hours for 10 days. disp:*20 doses* refills:*0* discharge disposition: extended care facility: - - discharge diagnosis: right foot ullcers & cellulitis right knee contracture aspiration pneumonia respiratory failure ards sepsis septic shock coag neg staph bacteremia pseudomonas uti & pneumonia discharge condition: good discharge instructions: tube feeds as tolerated. finish your courses of antibiotics. continue diuresis until you reach your baseline weight, unless you develop increasing creatinine or signs of renal failure. contact your md if you develop any concerning symptoms. followup instructions: *you should follow up with your primary care physician 1 month. *schedule an appointment with dr in his office () after you are discharged from the rehab hospital. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances temporary tracheostomy pulmonary artery wedge monitoring amputation above knee percutaneous [endoscopic] gastrojejunostomy injection or infusion of oxazolidinone class of antibiotics infusion of drotrecogin alfa (activated) diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia severe sepsis pneumonia due to pseudomonas other and unspecified angina pectoris pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot septic shock pressure ulcer, lower back alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance atherosclerosis of native arteries of the extremities with gangrene diseases of tricuspid valve diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy cellulitis and abscess of foot, except toes ulcer of heel and midfoot chronic osteomyelitis, ankle and foot contracture of joint, lower leg 

Answer: The patient is high likely exposed to