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: shellfish / percocet / zosyn / amiodarone attending: chief complaint: fever/hypotension major surgical or invasive procedure: placement of rt subclavian central venous catheter placement of rt antecubital picc line history of present illness: 70yof with h/o influenza a infection c/b ards s/p trach, afib, and tracheocutaneous fistula now presents with hypotension and fever. pts initially presented to in with influenza a infection complicated by ards and prolonged ventilator course requiring tracheostomy and was discharged to with tracheostomy tube but off ventilatory support. she returned with hypercarbic respiratory failure requiring mechanical ventilation through et tube. she was found to have a lll pna, paroxysmal rapid afib (hr 180s) and pneumomediastinum, upper esophageal dilatation, and uti. she underwent bronchoscopy which was apparently unremarkable, and was treated empirically with vancomycin and ceftazidime for pneumonia, and flagyl (for diarrhea). her course had been complicated by hypotension requiring levophed and rapid afib for which chemical cardioversion was attempted unsuccessfully with ibutilide. cultures revealed mrsa pna/bacteremia, and pseudomonas uti, and treatment was initiated with vancomycin and zosyn. she was then admitted to after short stay at osh for workup of pneumomediastinum. bronch at osh revealed no defects in the tracheal wall, and an esophageal gastrograffin study was negative as well. multiple imaging studies did not reveal any pneumomediastinum. repeat egd/rigid bronchoscopy did not show any te fistula, but the evidence for pneumomediastinum is that respiratory symptoms (hypercarbic failure) and af with rvr became worse when et tube was in higher position, and resolved when et tube was repositioned lower, presumably below the site of a fistula. her tracheostomy was revised and she had no recurrence of afib with rvr. the may many attempts for pressure support wean unsuccessfully so peg was placed and she was discharged to a chronic vent facility. of noted she was also found to be cdiff positive and completed a 14 day course of flagyl on as well as a 2 week for ciprfloxacin for sensitive pseudomonal uti. at rehab, the patient was noted to be hypotensive and tachycardic aafter blood transfusion last night. of not she also recently had increasing thick secretions suctioned from trach. she was being treated with linizolid for mrsa line sepsis changed to vancomycin and imipenem for gnr in urine and possible urosepsis, as well as po vancomycin for potential resistent c.diff. she was given 600cc bolus with minimal improvement and was given another 1l ns en route to hospital. in ed here she was febrile to 102 and persistently hypotensive despite wide open fluids so levophed was initiated. she transiently had hr of 150 and sbp in 200's requiring them to hold levophed. in total she received 5 l total of ns in ed and was given a dose of levofloxacin for suspected sepsis. past medical history: 1. influenza a in complicated by ards eventually leading to intubation, ventilatory support, and tracheostomy. 2. remote history of pneumonia. 3. status post left eye cataract surgery. 4. anxiety 5. dmii social history: no significant tobacco or alcohol use. family history: non-contributory. physical exam: vs: 99.8 | 110/75 | 75 | ac with tv 400 rr 14 fio2 50% peep 5 gen: intubated, somnolent but arousable, appears younger than stated age heent: pupils errl, mmm, no jvd, no carotid bruit neck:supple, no lad, cv: rrr, nl s1s2, no murmurs. chest: mild diffuse rhonchi but no crackles or wheeze abd: soft, nt/nd, +bs, no organomegaly. extr: warm well perfused, 2+ dp pulses, no cyanosis, diffuse anasarca neuro: pt not cooperating with exam, moving ue and le to command. pertinent results: bnp 1100 probnp: lactate:0.7 urine color: yellow appear: clear specgr: 1.012 ph: 6.0 urobil: neg bili:neg leuk: tr bld: lg nitr: neg prot: tr glu: neg ket: 15 rbc: wbc:0-2 bact: occ yeast: none epi: 0-2 lactate:0.7 hem 7 143 | 102| 69/ 88 agap=8 4.7 | 38 | 0.6\ ck: 12 mb: notdone trop-*t*: 0.03 ca: 6.8 mg: 2.0 p: 4.5 d alt: 105 ap: 195 tbili: 0.2 alb: ast: 108 ldh: dbili: tprot: : 74 cortsol: 33.0--> 49 mcv 94 wbc 8.5 hgb 8.2 plt 177 hct 25.4 n:86.3 l:9.0 m:3.3 e:0.9 bas:0.6 hypochr: 3+ anisocy: 1+ poiklo: 1+ macrocy: 1+ pt: 29.6 ptt: 30.7 inr: 3.1 micro: blood cx : mrsa. blood cx : ngtd.urine cx : pseudomonas. sputum cx : mrsa. 3:02 pm sputum gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (preliminary): sparse growth oropharyngeal flora. pseudomonas aeruginosa. moderate growth. aztreonam susceptibility testing requested by dr., (). sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 8 i meropenem------------- 4 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r ecg-nsr at 71, nl axis, lvh, mildly peaked tw in precordium, tw flat in avl, no other st or t changes cxr-impression: right-sided central line is seen with tip overlying svc. poorly defined opacity is seen in the left mid lung, appears more apparent on current study, possibly representing focal consolidation. evidence of increased mild-to-moderate pulmonary edema superimposed on chronic edema or chronic interstitial lung abnormalities. ct chest : the previously demonstrated pneumomediastinum has been completely resolved. the mediastinal lymph nodes are markedly enlarged measuring 13 mm in the right supracarinal area instead of 8 mm. the aorta is dilated measuring up to 4.5 cm in the ascending part unchanged. the density of the blood in the cardiac is diminished, suggesting anemia. the heart size is enlarged with no pericardial effusion. esophagus is dilated predominantly in its proximal part with air-fluid level suggesting esophagitis. bilateral pleural effusions are slightly increased. the bilateral widespread consolidations with prominent most probably infectious bronchiectasis are slightly diminished, especially in lower lobes and in left upper lobe. the et tube tip is 3 cm above the carina. the tip of the right and left central venous lines are at the level of cavoatrial junction. the images of the upper abdomen demonstrate normal liver, spleen, kidneys and pancreas. gallbladder with no evidence of acute cholecystitis is unchanged. the patient has prominent prominent subcutaneous fat stranding, most probably due to hypoalbuminemia. impression: 1. slight improvement of bilateral consolidation representing ards or widespread infection. 2. mild increase in bilateral pleural effusions. 3. cardiomegaly. 4. anemia. 5. gallbladder with no evidence of cholecystitis. 6. status post feeding gastrostomy insertion echo : 1. the left atrium is dilated. the right atrium is dilated. 2. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed. 3. the ascending aorta is mildly dilated. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 4. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. 5. no aortic dissection is seen up to 40 cm of probe insertion. brief hospital course: 70 year old woman with a history of influenza a infection complicated by ards s/p trachestomy, afib, and tracheocutaneous fistula now presents with hypotension and fever. 1) respiratory failure: appeared stable from oxygenation standpoint with worsening respiratory and metabolic acidosis over the past few days. cxr was unchanged from previous in regards to infiltrate but suggests some superimposed volume overload on underlying interstitial disease. patient's sputum culture grew pseudomonas sensitive to cefepime, ceftazidime, meropenem and zosyn. she had been started empirically on aztreonam and levofloxacin and as she improved clinically on this regimen it was continued. we requested add on sensitivities to aztreonam and these are pending at the time of this dictation. pseudomonas was resistant to ciprofloxacin. while in hospital she also developed a cuff leak despite elevated trach cuff pressures of 38. we discussed the issue with interventional pulmonary who recommended leaving this same trach in place as long as she continued to oxygenate and ventilate well since there was more risk of tracheomalacia in increasing the size of the trach or moving to a longer trach. under no circumstances should the cuff pressures be increased to >25-30. . 2) hypotension-there was possibility of transfusion reaction as hypotension occured in the setting of transfusion. fever suggested infectious etiology. possible sources included gnr from growing in urine at rehab, vap, and line sepsis with recent coag neg staph bacteremia although only culture bottles were positive, and this may have be a contaminant. pt had anemia with hx of dilated ascending aorta and ther was concern for dissection although she had equal bp in ue. tee was performed which showed no dissection. three sets of cardiac enzymes were negative. a cortisol stimulation test was negative. patient improved with antibiotics and pressors were weaned by day two of hospitalization. initially vancomycin was continued due to report of coag neg staph in blood culture at rehab, however, this was discontinued as it grew in only 1/4 bottles and was likely a contaminant. the urine culture from rehab grew enterobacter resistant to all antibiotics except gentamicin. as patient was improving with treatment for her pneumonia, did not change coverage to treat uti as likely not the pathogen in this situtation. she will continue on aztreonam. at the time of discharge she had completed 7 of 14 days. her left picc line was d/c'd. a rt picc line was placed prior to discharge. during her hospitalization she was treated through a right subclavian line which removed on day of discharge. . 3) anemia-pt had colonoscopy 2 years ago with only polps removed but has fam hx of colon ca. egd as part of te fistula workup was not full study but did not comment on source of ugib. iron studies were consistent with anemia of chronic inflammation. as patient did not have evidence of renal failure, darbopoetin was held. . 4) c. diff- as patient did not have diarrhea during this hospital stay po vancomycin was discontinued. . 5) afib: on coumadin with paf which she is not tolerating well with possible leaky capillary syndrome. patient had several runs of rapid afib during this hospital stay with resulting hypotension, therefore, despite risk of pulmonary toxicity, we loaded her with an amiodarone drip and then started 400 to be followed by 400 daily and then 200 daily. at the time of discharge she requires 2 more days of 400mg , then wean to 200mg mg daily and she should continue 200mg qd thereafter. electrophysiology was consulted and recommended amiodarone rather than sotalol. coumadin was restarted once hematocrit was stable. inr was therapeutic at the time of discharge. . 6) elevated lft's-likely due to sepsis and hypoperfusion. improved without intervention. she developed some nausea on hd4 which responded well to anzemet. it was unclear if this was med related but lft's were normal and no further workup was initiated since it cleared. . 7) psych - initially held citalopram since recently started, but patient complained of depressed mood and family wanted to start ssri so started zoloft with ativan prn for anxiety. . 8) fen: continued on tube feeds per peg. pt underwent metabolic cart which revealed respiratory quotient of 0.9 suggesting that her carbohydrate intake exceeded her need. her carbohydrate intake was decreased and her protein intake was increased to meet her caloric needs. her family raised the issue of borage oil supplementation but after discussion with nutrition it was felt this would be unhelpful and may cause problems with the peg tube so it was not started. . 9) ppx: bowel regimen, ppi, coumadin, pneumoboots, . 10) access: rt picc . 11) code: full code medications on admission: vancomycin 125mg q6h vancomycin 1g iv bid imipenem 500 q6h darbepoetin diltiazem 60mg q6h colace 100mg atrovent mdi lactinem prevacid 30mg qd magnesium gluconate 1g mvi zoloft 12.5mg qhs stopped asa 325mg qd tylenol ativan 0.5mg q6h prn coumadin 3mg qd sotalol 120mg bil albuterol mdi discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation qid (4 times a day). 5. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po bid (2 times a day). 7. warfarin 1 mg tablet sig: three (3) tablet po hs (at bedtime). 8. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 2 days. 9. amiodarone 200 mg tablet sig: one (1) tablet po twice a day for 7 days: starting on and finishing on . 10. amiodarone 200 mg tablet sig: one (1) tablet po once a day: to be started on and continued thereafter. 11. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 12. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. lorazepam 0.5 mg iv q8h:prn 15. aztreonam 1 g recon soln sig: one (1) recon soln injection q8h (every 8 hours) for 7 days: ending . 16. dolasetron 12.5 mg/0.625 ml solution sig: one (1) intravenous q8h (every 8 hours) as needed. discharge disposition: extended care facility: & rehab center - discharge diagnosis: trasfusion reaction pneumosepsis discharge condition: vital signs stable on ventilator discharge instructions: if you experience any fevers, chills, increasing sputum production, nausea or vomiting you should notify the rehab staff. followup instructions: please continue to follow-up with the doctors rehab including dr. for further management of your ventilator wean and response to the antibiotics for pneumonia. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances diagnoses: acidosis anemia of other chronic disease unspecified septicemia severe sepsis atrial fibrillation 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 pneumonia due to pseudomonas alkalosis tracheostomy status 

Answer: The patient is high likely exposed to