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: roxicet / penicillins / aspirin attending: chief complaint: lethargy and hypotension major surgical or invasive procedure: trach change history of present illness: 50 y/o male with a h/o squamous cell cancer of vallecula s/p xrt and tonsillar cancer w/ recent initiation of xrt and chemo,history of cirrohsis,history of seizure disorder on meds, history of trach and peg, who is transferred from rehab with lethargy and hypotension. he had recent admission for 2nd cycle of chemo/xrt which involved continued treatment of a pneumonia that had been diagnosed at rehab. his sputum grew multidrug resistant klebsiella so abx were changed to meropenem and discharged to rehab and completed course on . . prior to this admission, per family and ed records pt has been noted to have lethargy and over the past few days with sbp's in the 80's. this time she states he finished the meropenem on and on he became more lethargic and then began bringing up more sputum from his trach. she states he has not been tolerating tube feeds for the few days pta(was having nausea and vomiting) and so these have been held for most of the weekend. ivf were also held over the past few days. . she states at baseline (when he is on abx) he is up and walking around and able to care for his g tube on his own. he used to be able to talk with a passey muir valve, but last week his trach was downsized to a smaller one that does not allow him to talk. this has been very frustrating to him. . on arrival to the ed bp was 90/58 but then dropped to 74/41. 4l of ns were hung but the patient only received approx 1l ns before being transferred to the micu. on arrival to the micu bp was 135/75. in the ed he received cefepime 1g iv, vancomycin 1gm iv. wife states pt has had difficulty with edema in his legs in the past, and thus ns boluses were stopped and pt was placed on d5ns at 75 hour x 1l. . he is now stabilized in the micu and transferred to the floor. . micu course: -id- his was found to have mrsa and resistent klebsiella on sputum. id was also consulted. his abx was changed to meropenem and vancomycin. this was c/b leukopenia likely to meropenem. his wbc has been decreasing from 4k to 1.6k today. -pulm- given his sputum and sputum and infection, his trach was upsized to facilitate suction. -heme- his was found to have clot in left subclavin during flouro for picc. this was c/b low plt ? hit. this returned neg and was started lovenox as a bridge to coumadin. past medical history: -squamous cell cancer of the vallecula that was diagnosed in (t2n0m0). he was initially treated with radiation. pt later presented with dysphagia and ct of his neck revealed that he had a 2.8 x2.1 x 4.5 cm right tonisillar mass, unresectable tonsil cancer, which could be palliated with systemic chemotherapy and/or xrt or a combination of both. xrt and chemo (taxol/cddp) initiated in . -alcoholic cirrhosis -seizure d/o - last sz > 2y ago -psoriasis -g tube placed failure of swallow test -pancreatitis secondary to etoh -hepatic encephalopathy -bleeding esophageal varices -portal vein thrombosis social history: lives with his wife, although he has been in and more recently in acute rehab at rehab for the past months. former etoh. former smoking. family history: brother died of cad at age 34. physical exam: vitals: 99.3, 80, 135/75, 18, 93% on 6l trach mask, increased to 97% s/p suctioning and placement on 35% o2 via trach mask. general: 50m in nad, appears older than stated age heent: nc/at. perrla. eomi. mmm. neck: trach collar in place with beige secretions. cv: normal s1, s2 without m/r/g. pulm: coarse breath sounds b/l, otw ctab. abd: soft, nt/nd with normoactive bs. peg tube in place, c/d/i. ext: no c/c/e. psoriasis on b/l ue and le. neuro: pt not talking, but nodding head appropriately. pertinent results: head ct without contrast: there is no intra- or extra-axial hemorrhage, mass effect, shift of normally midline structures, or hydrocephalus. there is no major or minor vascular territorial infarction. the differentiation of the -white matter is preserved. density values of brain parenchyma are within normal limits. the surrounding soft tissues and osseous structures are unremarkable. impression: no evidence of acute intra- or extra-axial hemorrhage. no change compared to portable ap chest dated is compared to the prior pa and lateral from . tracheostomy tube is seen terminating in the mid trachea, good and stable position. a right picc line terminates in the mid axillary line. the heart size is normal. the pulmonary vasculature is normal. the hilar contours are stable. the lungs are clear. there is no pleural effusion or pneumothorax impression: no evidence for infiltrate. brief hospital course: 50 y/o male with a h/o squamous cell cancer of vallecula s/p xrt and tonsillar cancer s/p recent chemo/xrt and recent klebsiella pna admitted with recurrent lethargy and increased sputum: . # lethargy and increased sputum: likely recurrent tracheo-bronchitis, treated with antibiotics initially given poor baseline. resp therapist noted that trach plug smelled like pseudomonas. pt has been in rehabs/hospitals for last several months and has been exposed to many drug-resistant organisms. however, positive cultures (mrsa, esbl klebsiella) may represent colonization rather than true infection. abx stopped on and clinically well-appearing, with no fevers. -wbc continues to be low, possibly from meropenem; trending up off and received dose of neupogen yesterday -trach changed , still with thick secretions but strong cough -continue airway humidification as much as possible to help break up secretions -pt should not have his trach downsized in the near future, even at rehab due to problems with secretions accumulating and infections -picc changed and replaced (see below) . # hypotension: likely from dehydration given that wife reports tube feeds and ivf have been held x 4 days. pt responded quickly to 1l ns and now is normotensive. initially gave d5ns at 75 per hour until tf restarted. (family gives history of extensive le edema which is now not present but do not wish to overload with fluids). -continues to be normotensive, no further ivf needed for now -should have airway humidification as much as possible to avoid dehydration through trach . # left subclavian vein dvt: detected under fluoro for picc placement; not started on heparin overnight due to concern for hit; however, on discussion with heme/onc, pt previously worked up for hit and has intermittent thrombocytopenia - bridge to coumadin with lovenox (coumadin started ) . # elevated cr: only slightly elevated to 1.2 (baseline 0.7) on admission. likely from dehydration. creat down with hydration. . # onc: 2 primary head and neck cancers. -plan per oncology team . # psoriasis - cont on clobetasol cream. . # cirrhosis - cont lactulose and nadolol. lft's at baseline. . # seizure disorder - cont keppra and dilantin. dilantin level 15.9 in ed. (therapeutic is ). check dilantin level as may be interfering with wbc. . # fen - tube feeds, will change to bolus. cont reglan and use ativan and compazine prn nausea. . # access: has picc (needs tpa) and peripherals. . # code: full, discussed with patient medications on admission: -dilantin 100mg per gt q8am and qnoon, 200mg per gt q8pm -methadone 10mg per gt tid -compazine 10mg per gt q8 -reglan 10mg per gt q6 -atrovent nebs q6 -albuterol nebs q6 -nadolol 20mg daily -scopolamine patch 1.5 td q3 days -lactulose 30mg tid -mucomyst into trach -chlorhexidine 15ml swish and spit tid -clobetasol 0.05% cream apply to upper arms -clonidine 0.1mg per gt qhs -gabapentin 300mg po q8am and q2pm, 600mg qhs -simethicone 80mg qid -omeprazole 20mg daily -tylenol prn -dilaudid 4mg q4 prn -ambien 5mg qhs prn -ativan 1mg q6 prn discharge disposition: home with service facility: americare at home inc discharge diagnosis: pneumonia discharge condition: stable discharge instructions: please follow up with the doctor at your facility. he will need to check your blood to determine when you can stop the lovenox shots. please continue the full course of antibiotc meropenem as prescribed. followup instructions: provider: , md phone: date/time: 2:00 provider: , md, phd: date/time: 2:00 provider: , md phone: date/time: 11:45 md, procedure: enteral infusion of concentrated nutritional substances replacement of tracheostomy tube diagnoses: alcoholic cirrhosis of liver epilepsy, unspecified, without mention of intractable epilepsy acute bronchitis hepatic encephalopathy dehydration other psoriasis gastrostomy status attention to tracheostomy acute venous embolism and thrombosis of unspecified deep vessels of lower extremity personal history of malignant neoplasm of other and unspecified oral cavity and pharynx 

Answer: The patient is high likely exposed to