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: amoxicillin / tegretol / dilantin kapseal / heparin agents / benzodiazepines attending: chief complaint: foul smelling trach secretions major surgical or invasive procedure: bronchoscopy rigid bronchoscopy picc line placement history of present illness: 86 yo m with h/o tracheomalacia s/p multiple stents and revison, most recently y stent in , cva presents with pna, respiratory failure and partial tracheal stent occlusion. . at his baseline, patient has a trach and peg, is chronically ventilated and requires frequent suctioning at home. his home care givers noted increased foul smelling secretions from his trach. he was taken to worceter, where he was found to have significant opacification of his left lung. he was started on vanc/levofloxacin and amikacin for coverage of vap. a bronschopscopy was performed , which showed near total occlusion of the left main stem bronchus immediately distal to the stent. he was transferred here for possible stent revision with dr. . past medical history: 1) tracheomalacia, status post stent x 2 with failure secondary to stent migration. status post trach revision . status post t-tube removal on . : silicone y-stent revision and replacement. tracheostomy stoma revision. 2) status post stroke in with tia; right upper extremity weakness resulting. 3) hypertension. 4) seizure disorder. 5) history of mrsa. 6) hemorrhoids. 7) arthritis. 8) depression. 9) history of chf. 10) cri social history: married and lives at home with wife with nursing care. remote hx of smoking, duration unknown. rare etoh. has home ventilator. family history: nc physical exam: hr: 81 (75 - 81) bpm bp: 133/59(76) {118/59(76) - 133/64(78)} mmhg rr: 20 (16 - 20) insp/min spo2: 97% heart rhythm: sr (sinus rhythm) general appearance: anxious, diaphoretic head, ears, nose, throat: poor dentition, no(t) ng tube, trach cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: not assessed), (left radial pulse not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: bronchial: ) abdominal: soft, non-tender, bowel sounds present extremities: right lower extremity edema: 1+, left lower extremity edema: 1+ musculoskeletal: no(t) muscle wasting skin: not assessed neurologic: follows simple commands, responds to: not assessed, movement: not assessed, tone: not assessed, moved both toes, unable to move right arm, able to open mouth, squeeze left hand. pertinent results: 12:30am blood wbc-7.8 rbc-3.43* hgb-10.9* hct-33.4* mcv-98 mch-31.9 mchc-32.8 rdw-15.1 plt ct-201 04:33am blood wbc-8.4 rbc-3.05* hgb-9.8* hct-29.7* mcv-97 mch-32.0 mchc-32.9 rdw-14.9 plt ct-191 04:44am blood wbc-6.2 rbc-3.16* hgb-10.1* hct-30.7* mcv-97 mch-32.1* mchc-33.0 rdw-15.0 plt ct-195 12:30am blood pt-13.8* ptt-33.4 inr(pt)-1.2* 12:30am blood glucose-110* urean-25* creat-1.3* na-139 k-3.7 cl-104 hco3-25 angap-14 04:38am blood glucose-117* urean-25* creat-1.3* na-138 k-3.7 cl-103 hco3-23 angap-16 04:33am blood glucose-99 urean-25* creat-1.2 na-137 k-3.6 cl-103 hco3-26 angap-12 01:34am blood glucose-115* urean-24* creat-1.2 na-142 k-3.6 cl-107 hco3-25 angap-14 12:30am blood calcium-9.6 phos-2.9 mg-2.3 04:38am blood calcium-9.5 phos-3.2 mg-2.0 04:33am blood calcium-9.3 phos-3.3 mg-2.2 01:34am blood calcium-9.0 phos-2.9 mg-2.1 04:44am blood calcium-9.0 phos-2.2* mg-2.2 08:37pm blood phenoba-30.9 12:41am blood type- temp-37.2 po2-39* pco2-42 ph-7.45 caltco2-30 base xs-4 intubat-intubated 03:06am blood type-art temp-37.2 po2-108* pco2-35 ph-7.50* caltco2-28 base xs-4 . imaging: cxr: mild pulmonary edema is new and heart is slightly larger though still normal size. greater opacification in the left lower lung could be dependent edema and atelectasis but pneumonia cannot be excluded. pleural effusion is small on the left if any. no pneumothorax. chronic tracheostomy, tube is canted anteriorly and should be examined clinically to make sure it is properly placed. . cxr: there is improved aeration of the left lung with persistent left retrocardiac opacity which may be due to atelectasis or developing infiltrate. the tracheostomy tube tip is 6 cm above the carina. there is atelectasis at the right base and prominence of the pulmonary interstitial markings. . micro: sputum: gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (preliminary): further incubation required to determine the presence or absence of commensal respiratory flora. pseudomonas aeruginosa. moderate growth. gram negative rod #2. moderate growth. gram negative rod #3. sparse growth. brief hospital course: 86 yo m with h/o tracheobrachiomalacia s/p multiple stents now presenting with lll pna and respiratory failure. is s/p y-stent removal and debridement of left main stem bronchus on . #. ventilator acquired pna: likely all secondary to occluded stent and post obstructive pna. has gnrs in sputum, one + for psuedomonas others still pending, no sensitivities yet. he was initially on vanco/cefepime/levoflox. we are narrowing him to cefepime today and planning for a 14 day course. on the day of discharge he was day 5. he is to continue vent precautions with elevated hob and chlorhexidine. we will follow cultures here and call macu if not sensitive to cefepime. . #. tracheobronchomalacia: patient presented primary for y-stent assessment. had occlusion of left main stem bronchus with granulation tissue. is now s/p stent removal and granulation tissue debridement in or yesterday. had left lung collapse following procedure. was on 10 peep overnight with improved cxr this am. he should for now continue with peep of 10 on his ventilator. would likely be hesitant to try and wean peep for now until further eval by ip. they are going to contact the family and rehab with a time for follow up. it will be within the next 1-2 months for a repeat bronchoscopy. . # somnolence: resolved yesterday, per family he has had slow recovery in mental status from anesthesia in the past. was improved on the day of discharge. no change in labs or abg. think it was likely med effect. . #. s/p cva: stable rue weakness, will frequently turn, holding asa pre-op, stroke ppx with phenobarbital. he continued his phenobarbital and had stable level here. no dose changes. his aspirin was restarted on discharge. . # picc issue: picc was placed, but then pulled out on accident. picc team reevaluted and were able to replace a midline. . # htn: at home was on hctz, but normotensive here off of it. can restart as needed for blood pressure control at macu. . # ppx: was kept on lovenox dvt prophylaxis. changed dose based on renal function, was discharged on his home dose. medications on admission: meds on transfer: vanc 1g iv q12 insulin gtt esomeprazole 40mg po daily albuterol nebs enoxaparin 40 mg sc daily levofloxacin 750mg iv q24 phenobarbital 240mg po qhs amikacin 1250mg iv q48 discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 3. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 1-2 puffs inhalation q4h (every 4 hours). 5. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation qid (4 times a day). 6. phenobarbital 20 mg/5 ml elixir : two y (240) mg po qhs (once a day (at bedtime)). 7. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane tid (3 times a day). 8. enoxaparin 40 mg/0.4 ml syringe : one (1) syringe subcutaneous daily (daily). 9. cefepime 2 g iv q24h 10. cefepime 2 gram recon soln : two (2) grams intravenous once a day for 9 days: for total of 14 days. 11. flush : one (1) flush four times a day as needed for for flushing: flush picc line as needed with 0.9% sodium chloride flush. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: 1. tracheal stent obstruction 2. pneumonia discharge condition: mental status: confused - sometimes. mouths yes or no answers. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted to the hospital for a pneumonia and obstruction of your tracheal stent. you had a bronchoscopy at the bedside and then another one in the operating room. they were able to remove the stent and relieve the obstruction in the or. you did have some lung collapse after the procedure, so your venitlator setting were increased to keep your lung open. you need a course of antibiotics to treat the pneumonia. we made these changes to your medications: started cefepime, an antibiotic to be taken 9 more days followup instructions: please follow up with ip. they will contact you with a time to see them for repeat bronchoscopy in the next 1-2 months. please follow up with your pcp after you are discharged from rehab. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma endoscopic excision or destruction of lesion or tissue of bronchus endoscopic removal of bronchial device(s) or substances diagnoses: hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of tobacco use depressive disorder, not elsewhere classified chronic kidney disease, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute and chronic respiratory failure other late effects of cerebrovascular disease epilepsy, unspecified, without mention of intractable epilepsy ventilator associated pneumonia other complications due to other internal prosthetic device, implant, and graft pseudomonas infection in conditions classified elsewhere and of unspecified site tracheostomy status other diseases of trachea and bronchus dependence on respirator, status arthropathy, unspecified, site unspecified personal history of methicillin resistant staphylococcus aureus muscle weakness (generalized) unspecified hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to