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: sulfa (sulfonamide antibiotics) attending: chief complaint: fever major surgical or invasive procedure: central line placement blood transfusion history of present illness: mr is a 67 year old man with past medical history significant for dementia, urogenic bladder and prosthetic mitral valve, presenting with fever and urinary retention to , complicated by traumatic foley placement and hematuria as well as hypotension. . patient is a nursing home resident at newbridge on the () where we was noted to be febrile to 101 and to have diminshed urine output. although notes are sparse, it appears a foley catheter was changed , although with significant difficulty, and which resulted in gross hematuria (~1.8l of bloody urine). patient was then taken to where given amount of blood, there was concern about urethral injury / false lumen cannulation. patient received vancomycin / ceftriaxone and 2 units of ffp, and patient was transderred to for urological evaluation. . on arrival here, vital signs were initially: 97.6 80 88/palp 22 97. 3-way foley was placed by urology with bedside cystoscopy, and was continually irrigated, with about 1 liter of bloody urine was retrieved. patient was noted to be hypotensive to 80's and central line over left subclavian was placed. patient received a total of 4 liter ns, given a tender abdomen also a dose of flagyl was given and ct abdomen was obtained. patient is admitted to the micu for further evaluation. past medical history: multisystem organ atrophy neurogenic bladder recurrent urinary tract infections mitral valve replacement -- s/p valve bph -- requires chronic indwelling -- c/b penile trauma h/l mrsa infections dementia social history: lives at nursing home, no alchohol / drugs. sister, , very involved in his care. visits frequently. family history: noncontributory physical exam: gen:the patient is in no distress and appears comfortable skin:no rashes or skin changes noted heent:no jvd, neck supple, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. chest:lungs are clear without wheeze, rales, or rhonchi. cardiac: regular rhythm; no murmurs, rubs, or gallops. abdomen: no apparent scars. non-distended, and soft without tenderness extremities:no peripheral edema, warm without cyanosis neurologic: alert and appropriate. cn ii-xii grossly intact. bue , and ble both proximally and distally. no pronator drift. reflexes were symmetric. downward going toes pertinent results: admission labs: 06:10am pt-31.3* ptt-65.0* inr(pt)-3.1* 06:10am plt count-186 06:10am neuts-88.0* lymphs-7.4* monos-4.3 eos-0.2 basos-0.1 06:10am wbc-9.2 rbc-3.26* hgb-9.1* hct-27.6* mcv-85 mch-27.8 mchc-32.9 rdw-13.8 06:10am estgfr-using this 06:10am glucose-99 urea n-99* creat-6.7*# sodium-138 potassium-5.0 chloride-102 total co2-19* anion gap-22* 06:20am lactate-1.9 07:15am urine rbc->50 wbc->50 bacteria-many yeast-none epi-0 admission ecg: normal sinus rhythm at 82 with first degree av delay, left bundle branch block with notched qrs and left axis deviation, p wave in ii meets diagnositic criteria for left atrial enlargement, qt segment is normal. no prior for comparison, however no diagnostic criteria for ischemia in setting of lbbb. . studies: . ct abdomen: () soft tissue attenuation in the bladder likely reflective of blood clots. foci of calcification are seen in the bladder along the right lateral aspect; an underlying mass cannot be excluded. assoc. bilateral hydronephrosis and hydroureter. . cxr : in comparison with the study of , there is indistinctness of pulmonary vessels, especially at the left base, consistent with the clinical impression of elevated pulmonary venous pressure. atelectatic changes at the bases are seen, with possible small pleural effusions. in the appropriate clinical setting, the possibility of a left basilar pneumonia would have to be considered. brief hospital course: 67 year old nursing home resident with dementia, urinary retention and on systemic anticoagulation for valve at the mitral position, presenting with fevers, hematuria and hypotension. . # hypotension / urosepsis: in setting of nursing home residence, chronic urinary retention, concerning for early sepsis, most likely from urinary source given floridly positive ua at . he was given vanc/zosyn empirically. levophed and aggressive fluid resuscitation were used to support bp for a brief time after which he was weaned from pressure support. urine cultures from grew proteus sensitive to beta lactams and mssa (urine culture from also positive for mssa). antibiotic coverage was narrowed to iv nafcillin and he was subsequently switched to oral keflex. he was discharged back to his with 10d course of keflex for a total of 14 days of treatment. at the time of discharge, all blood cultures remain negative however are not finalized. these cultures should be followed up by his primary physician. # acute renal failure: although baseline renal function is not known, patient with very elevated creatinine (>6)on presentation. this significantly improved with placement of foley catheter suggestive of post renal / obstructive etiology. on discharge his creatinine was 1.2 and stable. . # supratherapeutic inr and hematuria: likely obstructed foley at nursing home. foley then replaced returning very bloody urine. there was concern about false cannulization. urology was consulted, and new foley placed with bedside cysto guidance. bleeding thought likely longterm foley causing trauma versus obstruction causing distention and capillary leakage vs traumatic foley replacement. inr supratherapeutic which may have contributed. reversal avoided mechanical mitral valve. cbi started and continued until urine cleared. patient had significant hct drop, he was transfused with an appropriate hct bump. the urine quickly cleared. cbi weaned and he had no further episodes of hematuria. hematocrit then remained stable and no further transfusions were required. inr trended down and coumadin was restarted as below. . # cardiac valvular disease: mechanical mitral valve requiring goal 2.5 to 3.5 to avoid thrombotic complications. coumadin initially held as inr supratherapeutic. inr trended down and coumadin was restarted at 2mg daily. given blood cultures negative, no tte was obtained. . # hypernatremia: thought most likely post obstruction diuresis. his electrolytes were followed closely. he was encouraged to drink free water and he got d5w x 1. his sodium improved and was well within normal limits for 2 days prior to discharge. . # abdominal distention: patient complained of abdominal distention and pain. he felt as though he was constipated. his exam was always reassuring without rebound or guarding. an aggressive bowel regimen was initiated. pain improved. . # agitation/delirium: he was briefly agitated while in the icu which was thought delirium in the setting of sepsis. with treatment of his infection his mental status improved and he was at his baseline prior to discharge. . # digoxin use: this was held on admission. it was never restarted as his heart rate was well controlled and he remained in sinus rhythm. . # depression: stable. fluoxetine continued. medications on admission: lovenox 80mg daily? coumadin provigil 200mg trimox 500mg calcium carbonate vitamin d2 lasix 20mg prozac 40mg tylenol digoxin 250mg qod discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 4. polyethylene glycol 3350 17 gram/dose powder : one (1) packet po daily (daily) as needed for constipation. 5. fluoxetine 20 mg capsule : two (2) capsule po daily (daily). 6. warfarin 2 mg tablet : one (1) tablet po daily (daily). 7. cephalexin 500 mg capsule : one (1) capsule po q6h (every 6 hours) for 10 days. capsule(s) 8. provigil 200 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: newbridge discharge diagnosis: urinary tract infection sepsis hematuria resolving acute renal failure discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to with a severe urinary tract infection, sepsis, and hematuria (blood in your urine). you were very ill and initially went to the intensive care unit. you were given iv fluids, antibiotics to treat your infection, and medications to help support your blood pressure. you had a new foley catheter placed because of the bleeding in your bladder. the bleeding stopped shortly after your bladder was irrigated. you did require one blood transfusion because you lost a significant amount of blood, however you were very stable after the bleeding stopped. you are going to be discharged back to your nursing home (newbridge). you will be taking antibiotics for your infection (keflex) for the next 10 days. we made a few changes to your other meications. we decreased your coumadin to 2mg daily. we stopped your digoxin and lasix. these changes will be reflected in the paperwork that we will send to your nursing home. you should talk to your doctor about whether or not these medications should be restarted. followup instructions: you should follow up with the physician at . provider: , md phone: date/time: 2:30 procedure: venous catheterization, not elsewhere classified other cystoscopy insertion of indwelling urinary catheter diagnoses: urinary tract infection, site not specified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia severe sepsis depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) heart valve replaced by other means long-term (current) use of insulin septic shock other left bundle branch block retention of urine, unspecified other constipation gross hematuria hyperosmolality and/or hypernatremia neurogenic bladder nos other degenerative diseases of the basal ganglia 

Answer: The patient is high likely exposed to