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: respiratory failure, fevers, delerium & inability to wean from vent major surgical or invasive procedure: trach change history of present illness: mr. was admitted on to after presenting on with hypotension, fevers, and acute renal failure likely thought to be due to urosepsis. he was treated with zosyn/cipro, but urine culture was negative and he responded to fluids. he did not require pressors. his antibiotics were tailored to zosyn alone. he remained predominantly on ac and was transferred due to inability to wean from vent and concern for trach leak and tbm. . of note, he has been in and out of hospitals since . he initially presented to on with back pain, sciatica, and parasthesias. he was found to have arf (cr 9.0), and hyperkalemia (k 7.5). his renal failure was thought to be due to nsaid use and he was urgently dialized for hyperkalemia. he was intuabed for repiratory failure secondary to pneumonia and airway protection for ams. he ultimately developed ards and was ultimately trached and peged. he was treated for pna with cefepime, vanco, impienem and daptomycin but had persistent fevers and delerium. he was anticoagulated for a rij line associated thrombus. he underwent an fuo workup which included a pet scan which showed increased marrow and splenic uptake. he ultimately improved and was weaned to ps throughout most of the day and then sent to on . . he was at for another month. he continued to have fevers and altered mental status which worsened over the past few days. he developed diarrhea and so tube feeds were held for several days. he was then sent to cha for fevers and hypotension. . upon arrival to micu, unable to obtain further history as patient is altered, portugese speaking only, and is not accompanied by family. past medical history: diabetes mellitus obstructive sleep apnea chronic kidney disease (baseline cr reportedly 2-2.5 - diabetic and hypertensive nephrophathy) morbid obesity gout social history: married, lives with wife and 24 year old sone. previously worked as a butcher, but now on disability choric back pain/sciatica. family history: mother had heart and kidney and died at 89 from renal failure. physical exam: vs: hr 95, bp 153/59, rr 21, 97% on ps 5/5 50% gen: trached heent: perrl, trach present cv: difficult to auscultate due to coarse breath sounds pulm: coarse breath sounds diffusely abd: obese, soft, nt, + g-tube ext: no periphearl edema pertinent results: admission labs: . 02:34am blood wbc-10.6 rbc-3.59* hgb-10.4* hct-33.5* mcv-93 mch-28.9 mchc-30.9* rdw-16.1* plt ct-426 02:34am blood neuts-67.9 lymphs-24.3 monos-3.9 eos-3.4 baso-0.4 02:34am blood pt-14.6* ptt-23.6 inr(pt)-1.3* 02:34am blood plt ct-426 02:34am blood esr-126* 02:34am blood glucose-198* urean-30* creat-1.4* na-147* k-4.2 cl-115* hco3-20* angap-16 02:34am blood alt-19 ast-40 ld(ldh)-616* alkphos-291* totbili-1.2 02:34am blood totprot-7.2 albumin-2.9* globuln-4.3* calcium-8.2* phos-2.2* mg-2.1 01:43pm blood caltibc-100* ferritn-2202* trf-77* 02:34am blood tsh-2.8 02:34am blood crp-111.1* 02:34am blood pep-polyclonal igg-* iga-473* igm-170 ife-no monoclo 05:51am blood type-art temp-37.0 po2-91 pco2-35 ph-7.43 caltco2-24 base xs-0 intubat-intubated 05:51am blood lactate-1.1 pertinent labs/studies: . hct: 33.3 () -> 24.9 () -> 21.2 () -> 23.0 () esr: 130 () alk phos: 291 -> 261 () ldh: 616 () -> 201 () bnp: 942 ca: 11.0 () -> 12.4 () -> 11.2 () ferritin: 2202 crp: 94.2 igg: iga: 473 . blood culture (): enterobacter cloacae. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- 4 s ceftriaxone----------- 8 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- =>128 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r sputum culture (): gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): oropharyngeal flora absent. enterobacter cloacae. moderate growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. staph aureus coag +. moderate growth. of two colonial morphologies. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivity testing performed by sensititre. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | staph aureus coag + | | cefepime-------------- <=1 s ceftazidime----------- 4 s ceftriaxone----------- 8 s ciprofloxacin--------- 0.5 s clindamycin----------- s erythromycin---------- =>4 r gentamicin------------ <=1 s <=2 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s oxacillin------------- =>8 r piperacillin---------- 32 i rifampin-------------- <=0.5 s tetracycline---------- s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r <=0.5 s vancomycin------------ <=1 s tte (): the left atrium is mildly dilated. the right atrium is moderately dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. all four of the cardiac valves were suboptimally visualized. no gross abnormalities of cardiac valve structure or function seen. impression: suboptimal image quality. no gross abnormalities of ventricular function or cardiac valve structure or function based on very limited image quality ct abdomen/pelvis (): 1. bibasilar atelectasis/consolidation and ground-glass opacities of the mid to lower lungs, significantly improved from , most likely resolving pneumonia. 2. no infectious process identified in the abdomen or pelvis. mri l-spine (): 1. findings which may represent discitis osteomyelitis or degenerative disc changes at the l5/s1 region. 2. findings likely representing myositis in the bilateral posterior lumbar muscles, right greater than left, extending from l4 to the lumbosacral junction. 3. severe multilevel degenerative changes extending from l3/l4 through l5/s1 as extensively detailed above with encroachment of the right descending l4 nerve root and likely on the descending left s1 nerve root. please refer to these levels for complete findings. wbc scan (): 1. no wbc uptake in the lumbar spine. 2. multifocal regions of abnormal white cell uptake. the uptake in the right ankle is of unclear etiology. this region may be further evaluated with physical exam and plain radiographs. right gluteal uptake appears separate from the bone and is likely at a site of soft tissue pressure sore with no frank ulceration noted on recent ct. residual lung uptake can be seen in setting of infection (may be residual pneumonia) or inflammation. 3. the right lower quadrant uptake in conjunction with recent ct is felt to represent normal variant accumulation of tracer in the cecum. tracheal uptake can also be normal in the setting of tracheostomy but should be correlated with physical exam for any signs of infection. brief hospital course: mr. is a 57 year old male with has had prolonged hospitalization and rehab stay over the last two months for acute renal failure requiring dialysis for one sessions secondary to nsaid use, altered mental status (delerium), fevers, now trached and peged. he is transferred to due to question of need of ip evaluation due to inability to wean from the vent. . respiratory failure. patient has been vent dependent for two months. while at , he was on ps for most of the day. he was noted upon arrival to have a positional trach leak in spite of cuff pressure of 40 cc/hr. ip increased the size of the trach from portex #7 to portex #8. patient was transitioned to trach collar mask after this and tolerated it well. cxr did not show evidence of pneumonia or fluid overload. patient was evaluated for a passy-muir valve, but due to increased tracheal pressure, he was not felt to be safe to use it. he will need re-evaluated in a few days following discharge. patient had a bronchoscopy by interventional pulmonology and was found to have significant tracheomalacia and will likely need a two part intervention once concern for active infection is resolved. patient was tolerated trach collar during the days and pressure support at night. interventional pulmonology was informed, and they will call to schedule a trach stent placement in one month's time. . altered mental status. patient has had intermittent delerium over the past two months in the setting of multiple insults (infections, respiratory failure requiring intubation and then trach, renal failure requiring dialysis). mental status improved during hospitalization in setting of being treated for urinary tract infection and ventilation associated pneumonia. although english is his second language, by time of discharge patient was able to follow simple commands in english. although he was transferred over to with the recommendation for a neuro evaluation and eeg, this was not performed due to improvement of mental status with treatment of infection. . fever. patient presented to osh with positive ua and fevers. his fever curve trended down with antibiotics. his urine culture was ultimately negative. he got a ct torso which showed only resolving pneumonia and atelectasis and no other infectious source. his glucan was found to be markedly elevated (>500). a lumbar spine mri showed question of osteomyelitis/discitis. however, wbc scan did not show evidence of such. he did however develop enterobacter bacteremia and enterobacter and mrsa in his sputum. for this, he was started on vanco/cefepime/cipro. id followed the pt, and he should continue these antibiotics until . the patient should undergo a two-week course of iv cipro from the time of discharge, ending . . acute renal failure. patient was found two months ago to be in arf with hyperkalemia requiring one session of dialysis. his creatinine was again elevated to 3.0 upon arrival to osh. his creatinine improved to 0.8 with hydration. . right ij line associated thrombus. patient is known to have rij thrombus. upon arrival, he was not anticoagulated, but the reason for this was unclear. was started on heparin to coumadin bridging for thrombus. a repeat u/s was performed on , which did not show evidence of thrombus. the patient's anticoagulation was thus discontinued, and he was started on sq heparin for dvt prophylaxis. . tachycardia. patient noted to have multifocal atrial tachycardia with rates up to 150s. he was put on diltiazem which was uptitrated to maximum doses and then started on metoprolol which was also uptitrated. at the time of discharge, he was on diltiazem 90 mg qid and metoprolol 37.5 mg tid. . sciatica: the patient has a history of sciatica and had persistent lower back pain as a result. he was started on ultram, lidocaine patch, and a fentanyl patch on this admission, which improved his pain. . type 2 diabetes: the patient has a history of dm2. he was placed on a humalog insulin sliding scale as well as glargine 12 units at night on this admission, and his sugars remained under good control. . hypercalcemia: the patient was noted to have hypercalcemia on this admission, which was thought to be secondary to the calcium he was being given each day. this calcium was discontinued, and the patient's calcium trended down. medications on admission: transfer medications: tylenol prn albuterol inh prn combivent prn calcium carbonate 1250 mg/5 ml tid diltiazem 60 mg morhpine 30 mg po q 6 hours nysttin topical to inguinal folds prn zosyn 2.25 iv q 6 hours day 4 prevacid 30 mg daily vitmain d 800 mg daily discharge medications: 1. acetaminophen 160 mg/5 ml liquid : ml po q6h (every 6 hours) as needed for pain, fever: please give through ng tube. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 2-4 puffs inhalation q2h (every 2 hours) as needed for sob. 3. ipratropium bromide 17 mcg/actuation aerosol : four (4) puff inhalation qid (4 times a day). 4. diltiazem hcl 30 mg tablet : three (3) tablet po qid (4 times a day): please give through ng tube. . 5. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed for rash. 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 8. oxycodone 5 mg/5 ml solution : five (5) ml po q6h (every 6 hours) as needed for severe pain. 9. tramadol 50 mg tablet : one (1) tablet po q8h (every 8 hours) as needed for pain. 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily): please apply to lower back. 11. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 12. polyvinyl alcohol 1.4 % drops : 1-2 drops ophthalmic q3h (every 3 hours) as needed for dry eyes. 13. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 14. senna 8.8 mg/5 ml syrup : five (5) ml po bid (2 times a day) as needed for c. 15. ciprofloxacin 250 mg tablet : two (2) tablet po q12h (every 12 hours): last day of antibiotics = . 16. cefepime 2 g iv q12h 17. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eye. 18. quetiapine 25 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 19. quetiapine 25 mg tablet : 0.5 tablet po qam (once a day (in the morning)). 20. metoprolol tartrate 25 mg tablet : 1.5 tablets po tid (3 times a day). 21. citalopram 20 mg tablet : two (2) tablet po daily (daily). 22. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 23. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 24. ondansetron 4 mg iv q8h:prn n/v 25. insulin glargine 100 unit/ml cartridge : twelve (12) units subcutaneous at bedtime. 26. humalog 100 unit/ml cartridge : as directed units subcutaneous four times a day: please use according to insulin sliding scale attached. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: respiratory failure urinary tract infection acute renal failure enterobacter bactermia ventilator associated pneumonia multifocal atrial tachycardia secondary: type 2 diabetes sciatica. discharge condition: good. patient was tolerating trach collar mask for > 24 hours prior to discharge. discharge instructions: you were admitted to the hospital because you had fevers and altered mental status. you were found to have a urinary tract infection, which we treated with antibiotics. you were also found to have a pneumonia from being on the ventilator, as well as bacteria in your blood. we are treating you currently with two antibiotics, and your clinical status has improved tremendously. you were also evaluated by interventional pulmonary during this hospitalization, who increased the size of your tracheostomy tube. . while you were here, we made the following changes to your medications: 1. we discontinued your calcium and vitamin d, as you calcium level was very high. 2. we increased your diltiazem to 90 mg qid 3. we discontinued your morphine and started you on a fentanyl patch, ultram, lidocaine patch, and oxycodone as needed 4. we discontinued your zosyn and started you on vancomycin, cipro, and cefepime. 5. we started you on colace and senna 6. we started you on chlorhexadine mouth wash 7. we started you on quetiapine for agitation. 8. we started you on metoprolol because of your rapid heart rate. 9. we decreased your citalopram dose to 40 mg daily. please take all medications as prescribed. please keep all previously scheduled appointments. . please call your physician or come to the emergency department if you have shortness of breath, fevers, chills, confusions, or any other concerning symptoms. followup instructions: please follow up with your primary care physician , within 1-2 weeks after discharge from . please follow up with interventional pulmonology in one month for a trach stent placement. you will be contact about this appointment at . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma replacement of tracheostomy tube replacement of gastrostomy tube diagnoses: sciatica anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) other chronic pain hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation 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 specified cardiac dysrhythmias bacteremia long-term (current) use of insulin pressure ulcer, other site morbid obesity pressure ulcer, buttock hyperosmolality and/or hypernatremia ventilator associated pneumonia lumbago delirium due to conditions classified elsewhere diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled mechanical complication of other vascular device, implant, and graft hypercalcemia other diseases of trachea and bronchus pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms attention to gastrostomy mechanical complication of tracheostomy methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to