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: penicillins / heparin agents attending: chief complaint: brbpr major surgical or invasive procedure: colonoscopy egd history of present illness: 67 m now 32 days s/p aaa repair in at med center who presented from rehab with brbpr. he was originally admitted to osh on with back pain. found to have an 8x8 cm aaa and underwent surgery semi-urgently. aaa repair was complicated by occlusion of renal arteries, and then followed by open abdominal renal bypass procedure. hospital course was complicated by respiratory failure and ~2 week intubation. also c/b renal failure requiring hd, strep viridans bacteremia (on vanc and zosyn for unknown course), neutropenia thought secondary to an antibiotic, treated with neupogen per heme c/s note, thrombocytopenia (hit ab neg) thought secondary to antibiotics/meds v. sepsis, diffuse petechial or maculopapular(?) rash noted on (evaluated by derm, shave biopsy obtained, thought drug reaction from beta lactam, treated with triamcinolone cream), and delerium (psych was c/s'ed-thought was toxic-metabolic and subsequently felt he was depressed). . he was transferred to rehab on . he was noted on to have dark blood coming from his rectal bag. the patient noted that during the week prior to admission he had felt some rectal irratation, and had noticed small amounts of blood in and around the rectal bag. the flexi-seal with rectal balloon had been in place for weeks- apparently because the pt was bedbound. his wife says that he has been bed bound for the last month (first time out of bed was yesterday). she also says that at baseline he is very sharp, very oriented and quick. she says now he is slower, more easily confused, though he is much improved from when he was "rambling" in the icu. she also says his rash is much improved from before, it used to be more red and raised and covered his entire body including his face. it has recently started "drying up". . ed course: t98.1 hr60 bp 153/80 rr 20 o2sat 96% ra. received 1.5l ns, protonix 40mg iv, d5w w/3amps bicarb, cipro 400mg iv x1. he was admitted to surgery as there was concern for fistula from aaa. ct scan did not show any fistula. gi was consulted and planned for scope today. he is being treated empirically for a uti with cipro based on u/a. . currently ros: the patient denies sob, cp, palpitations. he does complain of shaking chills, he wants the temperature turned up. he denies cough. no nightsweats. he denies abdominal pain. he feels that he is weaker than baseline. past medical history: ** sx infrarenal 8x8cm aaa (non-ruptured), semiurgently repaired c/b covering of renal a requiring l eia to l renal bypass 4mm ptfe c/b arf on cri - requiring hd c/b resp failure - 16 day intubation, pna c/b staph con bacteremia (vanc dc'ed ), mastoiditis c/b rash - on solumedrol c/b neutropenia - neupogen cad s/p stent in dm htn hypercholesterolemia morbid obesity gout r eye blindness from injury in 8th grade cri (before aaa repair) oa r knee surgery yrs ago r foot surgery social history: ex smoker, quit 30-40 yrs ago, no etoh, lives with wife, has 2 sons, owns and manages property, retired salesman, no psych history family history: non contributory physical exam: vs: t 99, hr 93, 130/62 94% ra fs196 gen: obese male laying in bed in nad- alert and talkative, but occasionally chattering teeth, occasionally scratching skin heent: anicteric, mmm, no oropharyngeal lesions skin: full body (arms, trunk, legs) blanching maculopapoular rash with some areas of hyperpigmentation and scaling. face hyperpigmented with no current papules. arms with some areas fresh erythematous papular lesions, and other appear older, more confluent, more flat and hyperpigmented. on distal legs also has petechiae. chest: lungs sounds cta b/l heart: rrr no m/r/g abdomen: midline abdominal scar, obese, nontender, +bs extremities: no edema, no cyanosis, 2+dps neuro: oriented to person, place, , cns intact, ue strength (though mild shaking with exertion), knee, ankle strength b/l, has some r>l difficulty lifting straight leg against resistance pertinent results: urine studies 02:00am urine rbc-* wbc->50 bacteria-many yeast-none epi-0-2 02:00am urine blood-lg nitrite-pos protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 02:00am urine color-yellow appear-cloudy sp -1.014 admission hematology 02:00am pt-13.2 ptt-26.2 inr(pt)-1.1 02:00am plt smr-normal plt count-185 02:00am hypochrom-occasional anisocyt-normal poikilocy-1+ macrocyt-normal microcyt-normal polychrom-normal target-occasional schistocy-1+ teardrop-1+ 02:00am neuts-80* bands-3 lymphs-5* monos-1* eos-5* basos-0 atyps-1* metas-3* myelos-2* 02:00am wbc-6.3 rbc-4.14* hgb-12.3* hct-36.4* mcv-88 mch-29.8 mchc-33.9 rdw-14.7 admission chemisty 02:00am albumin-3.6 calcium-8.9 phosphate-2.7 magnesium-1.8 02:00am ck-mb-notdone 02:00am lipase-102* 02:00am alt(sgpt)-33 ast(sgot)-23 ck(cpk)-52 alk phos-99 tot bili-1.5 02:00am estgfr-using this 02:00am glucose-132* urea n-40* creat-1.3* sodium-137 potassium-4.5 chloride-103 total co2-25 anion gap-14 02:23am hgb-12.5* calchct-38 02:23am lactate-2.4* 02:52am k+-4.2 08:00am fibrinoge-127* 08:00am pt-13.5* ptt-26.9 inr(pt)-1.2* 08:00am plt count-203 08:00am wbc-6.0 rbc-3.95* hgb-11.3* hct-33.9* mcv-86 mch-28.6 mchc-33.4 rdw-15.6* 08:00am calcium-8.2* phosphate-2.1* 08:00am amylase-69 08:00am glucose-166* urea n-36* creat-1.2 sodium-135 potassium-4.0 chloride-101 total co2-25 anion gap-13 08:07am lactate-2.1* 02:46pm hct-35.6* . egd erythema in the stomach body compatible with very mild gastritis . colonoscopy subtle erosion in the rectum- not likely to be source of bleeding . cta chest and abd w & w/o contrast 1. near complete infarction of the right kidney, likely secondary to occlusion of the main right renal artery secondary to endovascular graft. 2. status post repair of 7.7 cm abdominal aortic aneurysm without evidence for leak. 3. rectal balloon tube device. the rectal wall can not be adequately evaluated. 4. 6.5 cm fluid collection in the right upper quadrant with very mild adjacent stranding is likely to be a seroma. infection is not favored but cannot be definitively excluded. chest ct on 1. mild decrease in size of a contained fluid collection within the right upper quadrant, which demonstrates similar characteristics and may represent a seroma. 2. fluid collection anterior to the left femoral vessels with a large superficial skin defect in this region. 3. status post repair of a 7.7-cm abdominal aortic aneurysm without evidence of leak. status post left iliac-left renal artery bypass with fluid and post- surgical changes at the proximal and distal anastomotic sites. 4. near complete infarction of the right kidney, unchanged. 5. mixed nodular and linear opacities within the right lung base. findings most consistent with atelectasis/scar, however, given the nodularity, a followup ct in three to six months is recommended to evaluate for change. a tiny 2-mm subpleural nodule in the left lung base may also be evaluated at this time. cxr no acute cardiopulmonary process transthoracic echocardiogram the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: suboptimal study. no definite evidence of endocarditis seen. transesophageal echocardiogram no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no valvular vegetations, paravalvular abscess, or significant regurgitant valvular disease seen. microbiology: joint fluid gram stain-final; fluid culture-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-pending inpatient blood culture blood culture, routine-final inpatient 9:23 pm urine source: catheter. urine culture escherichia coli. >100,000 organisms/ml.. sensitive to aztreonam (<=1 mcg/ml). escherichia coli. >100,000 organisms/ml.. 2nd morphology. sensitive to aztreonam (<=1 mcg/ml). pseudomonas aeruginosa. >100,000 organisms/ml.. sent to laboratories for colistin sensitivity testing. aztreonam = intermediate. aztreonam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | pseudomonas aeruginosa | | | amikacin-------------- =>64 r ampicillin------------ =>32 r =>32 r ampicillin/sulbactam-- 16 i =>32 r cefazolin------------- <=4 s 16 i cefepime-------------- <=1 s <=1 s 32 r ceftazidime----------- <=1 s <=1 s 16 i ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 8 s 16 i ciprofloxacin--------- =>4 r =>4 r =>4 r gentamicin------------ <=1 s <=1 s =>16 r meropenem-------------<=0.25 s <=0.25 s =>16 r nitrofurantoin-------- <=16 s <=16 s piperacillin---------- 32 i 64 i 32 s piperacillin/tazo----- <=4 s <=4 s 64 s tobramycin------------ <=1 s <=1 s =>16 r trimethoprim/sulfa---- =>16 r =>16 r wound culture gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. smear reviewed; results confirmed. wound culture (final ): escherichia coli. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- 8 s ceftriaxone----------- 2 s cefuroxime------------ 32 r ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin---------- =>128 r piperacillin/tazo----- <=4 s tetracycline---------- r tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r anaerobic culture (final ): no anaerobes isolated. blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient 11:50 am urine source: catheter. **final report ** urine culture (final ): pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. aztreonam = intermediate sensitivity testing performed by . escherichia coli. ~7000/ml. aztreonam = sensitive at <=1 mcg/ml. pseudomonas aeruginosa | escherichia coli | | amikacin-------------- =>64 r ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- 16 i <=1 s ceftazidime----------- 4 s <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ =>16 r <=1 s meropenem------------- =>16 r <=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 32 s =>128 r piperacillin/tazo----- 32 s <=4 s tobramycin------------ =>16 r <=1 s trimethoprim/sulfa---- =>16 r 8:00 pm urine source: cvs. urine culture (final ): enterococcus sp.. 10,000-100,000 organisms/ml.. ampicillin------------ =>32 r linezolid------------- 2 s nitrofurantoin-------- 256 r tetracycline---------- =>16 r vancomycin------------ =>32 r brief hospital course: 67 y.o. male with cad, dm, cri s/p recent aaa repair complicated by renal infarction, bacteremia, anemia and thrombocytopenia who presented with rectal bleeding around rectal tube device. he presented and/or was treated for additional problems, including urinary tract infection, infection of surgical wound, and soft infection tissue of elbow, each dissected and discussed below. rectal bleeding: initial concern for herald bleed from an aorto-enteric fistula, although was not visualized on ct scan. another possibility considered was local ulceration (i.e. stercoral ulcer) from long-term rectal balloon. had egd/ that showed mild gastritis (none at 3rd portion of duodenum where there would be concern for fistula) and a small ulceration in the rectum not actively bleeding. this was felt to be the cause of bleed. hct remained stable over the course of hospitalization though had some fluctuations, but he did have one transfusion. aspirin was restarted. recent stools were guaiac negative. chronic kidney disease anemia had rectal bleed and is on epo as outpatient for chronic kidney disease. he is on 20,000 units q week. will cont to get epo as outpt. heparin induced thrombocytopenia: hit ab neg at outside hospital. had a nadir ~60,000 at osh. hit ab was tested at and was positive. no heparin products were administered. his platelets were monitored and returned to limits. avoid all heparin products/flushes urinary tract infection with highly resistant pseudomonas and e. coli: pt was febrile to 100 initially in the hospital. he was started on ciproflox for uti. he was treated with vanc and zosyn at the osh was an unknown duration of time. blood cx sent here were negative but urine culture grew highly resistant pseudomonas and e. coli. additionally, he had an infected wound seroma also with highly resistant e. coli. he was started on aztreonam as below. f/u culture with asymptomatic bacturia/vre follow-up ua was negative, but culture was positive for 10k-100k of vancomycin resistant enterococcus. this might represent colonization given that his u/a was negative and that he had no symptoms. this was sensitive to linezolid, which should be started should he develop any fever or urinary symptoms. left femoral surgical wound infection/seroma growing highly resistant e. coli, id and vascular surgery reviewed ct and the infection does not appear to be contiguous with the graft. started on aztreonam to complete 14 day course. elbow pain/cellulitis/tendonitis the patient began to complain of red/swollen/painful left elbow. he had gout in the elbow previously, but his focal pain seemed to be outside of the joint. physical exam demonstrated no articular pain but pain more at the triceps insertion. there was an initial area of crepitace around that area. ultrasound demonstrated no clot. the bursa was tapped with negative culture and insufficient fluid for cell count. xray demonstrated only soft tissue swelling. he began, in consultation with id, a 14 day course of vancomycin for presumed cellulitis with improvement. delirium: the patient had ams since extubation at osh. he demonstrated delirium over the first few days of admission. he had been bed bound with little activity for a month. his benadryl for skin rash was discontinued. most likely his delerium multifactorial including medication and toxic-metabolic etiologies. no focal neuro deficit was noted. ms improved over the hospital course. he should not take benadryl. 1st degree atrioventricular block, new, r/o endocarditis the patient was noted to have a prolonged pr on ecg obtained because of sinus tachycardia. this was new from admission. given the history of viridans bacteremia at the referring hospital, echocardiograms were obtained to evaluate for perivalvular abscess. blood cultures remained negative throughout his hospitalization but he had intermittently received antibiotics. electrophysiology and cardiology consultations were obtained. the av delay was thought to be due to dual tracts within the av node; when the patient was tachycardic, the slow av pathway superceded the fast av pathway. 2nd degree atioventricular block / osa the patient had dropped beats on telemtry and was found to have at least two periods where he had nonconducted p waves x3 and had ventricular escape. ep thought this was most likely vagal surge in setting of obstructive sleep apnea (these occured at night) and recommended sleep study. cardiology/ep stated that it was safe to restart beta blockers. depression: sw saw frequently and he was continued on outpatient medications. desquamating drug rash: historically, this was related to pip-tazo. it was primarily maculopapular and pruritic and later became desquamating, and affected arms, trunk, and legs. sarna was continued for pruritis. triamcinolone cream was continued. diabetes: pt was uptitrated on lantus to 17units daily, including an insulin sliding scale. cad s/p stent : aspirin was held given the gi bleed. it was restarted after the egd did not show any soruce of bleeding. he was on iv metoprolol initially. he was switched to metoprolol 25 po bid. simvastatin was started. ckd: cr was slightly up, likely prerenal from skin losses, improved w/ 1lns of note, he had unilateral renal infarction following his aaa repair aaa repair: pt was followed by vascular surgery here. he has a follow-up appointment wtih dr. in . fen: mech soft diabetic diet w/ thin liquids, sugar free health shakes code: full communication: hcp wife h c medications on admission: epo 20k qwk tylenol needed benadryl prn mom budesonide 0.5 ih asa 325 daily lopressor 25mg po bid acyclovir cream tp qid x 1wk ativan prn hydralazine 10 q6 prn riss triamcinolone 0.1% cream tp discharge medications: 1. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed. 2. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day) as needed. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. epoetin alfa 4,000 unit/ml solution sig: 8,000 units injection qmowefr (monday -wednesday-friday). 8. lorazepam 0.5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. simvastatin 40 mg tablet sig: 0.5 tablet po daily (daily). 12. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous every twenty-four(24) hours for 3 days. 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. 14. insulin lantus(glargine) 17 units each evening regular insulin sliding scale qac + qhs 51-150 mg/dl 0 units 151-200 mg/dl 2 units 201-250 mg/dl 4 units 251-300 mg/dl 6 units 301-350 mg/dl 8 units 351-400 mg/dl 10 units discharge disposition: extended care facility: - discharge diagnosis: primary: abdominal aortic aneurysm urinary tract infection with urosepsis abdominal wound infection rectal bleeding secondary: chronic kidney disease diabetes mellitus gout obesity discharge condition: stable vital signs, feels well. ms: oriented x3, appropriate. discharge instructions: you were admitted for bleeding from rectum that was most likely from your rectal tube that was being used. the colonoscopy and egd did not show any other source of bleeding. for your urinary tract infection and surgical wound infection, you were treated with aztreonam for a full 14 days. for your elbow tendonitis/cellulitis (soft tissue infection), you were treated with vancomycin. . please take all medications as prescribed. you are continuing on antibiotics, vancomycin through . if you have chest pain, shortness of breath, dizziness, palpitations, nausea, vomitting, diarrhea, pain in abdomen, blood in stools please call the doctor on call. . followup instructions: vascular surgery: cat scan phone: date/time: 10:30am , md phone: date/time: 11:45 * please arrive 1.5 hours early for check-in and ct scan at , bldg please make a follow up appointment with your primary care provider dr within 2 weeks of discharge you had an irregularity on your ct scan in the bottom of your right lung. this was likely to be deflated lung, but a follow-up ct scan was recommended for you in months. please discuss this with your pcp. md, procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine colonoscopy diagnoses: other postoperative infection urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, stage iii (moderate) cellulitis and abscess of upper arm and forearm anticoagulants causing adverse effects in therapeutic use hemorrhage of rectum and anus 

Answer: The patient is high likely exposed to