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 56-year-old woman with non-insulin dependent diabetes mellitus, coronary artery disease, status post three vessel coronary artery bypass graft in , end stage renal disease on hemodialysis, rushed to the emergency room with fever for three days, shortness of breath and right sided chest pain. she has been meanwhile at home receiving visiting nurse care. she states the fever at home was as high as 101.4 degrees. she was previously admitted to ct surgery service for median sternotomy wound drainage which required iv antibiotics and wound debridement. at home she denies any productive cough, wheezing or wound drainage. the symptoms were first noticed by the patient two days ago and have worsened over the past several days. past medical history: as described in history and physical. medications: on admission, aspirin 81 mg po q day, premarin 0.625 mg po q day, norvasc 5 mg po bid, trazodone, hydroxyprogesterone, neurontin 300 mg po bid, ultram 50 mg po q day, lipitor 10 mg po q day, pravachol 0.25 mg po q day, lopressor 12.5 mg po bid. allergies: no allergies. past surgical history: status post cabg times three on . physical examination: on admission, t max 101.5, blood pressure 106/70, pulse 88, respirations 16, fao2 90% on five liters. in general, alert and oriented times three, conversant, pulmonary clear to auscultation left, decreased breath sounds at the right base. cv, regular rate and rhythm. chest wall, sternotomy wound, the bottom half of the midline sternotomy incision is opened with fibrinous exudate and 0 drainage. there is a click appreciated when the patient coughs. abdomen soft, nontender, non distended. right saphenectomy site, small area of erythema and a large amount of scab. both feet are warm. there is trace edema in the right lower extremity. pertinent studies: chest x-ray, bilateral pleural effusion, no evidence of chf, effusion is greater on the right side vs the left. chest, no pulmonary embolism, no infiltrate or consolidation, some modest right effusion with right lower lobe atelectasis, small left effusion, small amount of fluid in the anterior mediastinum, no pneumomediastinum. labs, cbc with white count 14.0, hematocrit 27.2, platelet count 330,000, differential of 95% neutrophils, 0% bands. chemistries, sodium 135, potassium 5.2, chloride 93, co2 28, bun 54, creatinine 6.7, glucose 264. hospital course: the night of admission a thoracentesis was performed in the right posterior thorax. approximately 500 cc of fluid was removed. also on the night of admission the saphenectomy wound was sharply debrided, the bleeding tissue impacted with wet to dry dressing and normal saline and the sternal wound was sharply debrided. the granulation tissue was packed with wet to dry dressings and normal saline. the patient was empirically started on piperacillin and vancomycin. plastic surgery was consulted, they recommended conservative management as was being performed by general surgery. the patient was also seen by the renal service who managed the patient's dialysis and electrolyte management during the hospitalization. picc line was placed in anticipation of a long course of iv antibiotics. on a vac dressing was first placed in the wound. the patient was doing well on intravenous antibiotics and vac dressing changes. the hospital course faltered when at hemodialysis, increased venous pressures were noticed on . on fistulogram revealed a clotted fistula and the patient was unable to receive her normal dialysis on . transplant surgery saw the patient and scheduled her for revision. during the interim, quinton catheter was placed in the patient's right groin for dialysis. on the evening of , the patient fell getting out of bed. when the house officer arrived, the patient was confused in bed and somewhat difficult to arouse. ct scan of the head performed on an emergent basis demonstrated no intracranial pathology. initially the skull was intact. the next morning the patient was difficult to arouse and her labs reflected the fact that she had not been dialyzed in several days with a rising bun, creatinine and potassium. the patient was given kayexalate for the rising potassium. a repeat ct scan of the head was similar to the previous ct scan in that there was no evidence of intracranial pathology. at this point the patient had an episode of bradycardia with wide qrs complexes. she lost consciousness. after receiving an amp of d50 insulin and calcium gluconate, the patient was transferred to the intensive care unit. at this point her hematocrit was found to be 13. the patient vomited a large amount of guaiac positive material. in the intensive care unit the patient was transfused four units of packed red cells and 4 units of ffp. the patient was intubated and an ng tube was placed. large amount of bloody material was aspirated from the stomach. gi service was consulted for an emergent egd which revealed an enormous amount of clot protruding from the pylorus and bright red blood was seeping around it. the gastroduodenal artery was visualized in the posterior wall of the duodenum. the patient was given blood and ffp to maintain hematocrit and to combat an ongoing coagulopathy. on the patient went to the interventional radiology suite and had an angioembolization of the gastroduodenal artery. at this point patient was placed on protonix and started on a course of amoxicillin and clarithromycin in addition to the piperacillin and vancomycin. the patient received her dialysis in the icu beginning on . during this course in the intensive care unit, the patient remained intubated and was repeatedly transfused to keep her hematocrit above 30. by the patient's mechanics were good enough to begin a wean from the ventilator and by she was extubated. by the patient was transferred to the patient care floor. the patient continued to do well on the floor, the vac dressing changes to the sternum were continued and the size of the sternal wound had decreased with time. additionally, the saphenectomy sites were cared for with wet to dry dressings which were changed over to santyl dressings twice a day. both wounds were intermittently debrided to reveal viable tissue. on the transplant surgery service deemed the patient an operable candidate and brought her to the operating room for fistular revision. please see previously dictated operative note for more details. after the fistula revision the patient was able to use her fistula for hemodialysis and the quinton catheter was removed. the vac dressing changes continued. the hospital course was complicated further by a brief episode of c. difficile colitis. for this, the patient was treated with flagyl for 10 days and remained on piperacillin and vancomycin. by the patient was accepted to . at this point patient's wounds were stable, she had a picc line in place, was tolerating po and was ready to go to rehabilitation. condition on discharge: stable. discharge disposition: to rehab. discharge medications: regular insulin sliding scale as follows: glucose 150-200 gets 2 units, 201-250 gets 4 units, 251-300 gets 6 units, 301-150 8 units, epogen 14,000 units q hemodialysis, vitamin a, d, zinc ointment to affected area tid, vancomycin 500 mg iv after hemodialysis times 6 weeks, neurontin 500 mg po bid, norvasc 5 mg po bid, trazodone 100 mg po q h.s., lopressor 25 mg po bid, lipitor 10 mg po q h.s., piperacillin 3 gm iv q 8 hours for 6 more weeks, captopril 12.5 mg po q 8 hours, protonix 40 mg po q day, miconazole powder applied to affected areas prn, morphine sulfate 2 mg iv before dressing changes. discharge diagnosis: 1. sternal wound infection. 2. infection of saphenectomy site. 3. gastrointestinal bleed, status post embolization. 4. c. difficile colitis. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more hemodialysis venous catheterization for renal dialysis thoracentesis injection or infusion of other therapeutic or prophylactic substance arteriography of other intra-abdominal arteries nonexcisional debridement of wound, infection or burn revision of arteriovenous shunt for renal dialysis injection or infusion of cancer chemotherapeutic substance diagnoses: other postoperative infection unspecified pleural effusion aortocoronary bypass status defibrination syndrome intestinal infection due to clostridium difficile other complications due to renal dialysis device, implant, and graft acute duodenal ulcer with hemorrhage, without mention of obstruction diabetes with other coma, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to