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: the patient is a 64 year-old female with end stage renal disease on hemodialysis secondary to diabetes mellitus, status post right femoral av graft with stable hematoma, who was noted to have a temperature of 100.2 associated with rigors at hemodialysis on day of admission. the patient was sent to the emergency department. upon arrival she was noted to have a temperature of 101.8 and her blood pressure was stable. in addition, the patient complained of back pain, fever, nausea and vomiting. the patient denied loss of bowel and bladder function or lower extremity weakness and abscess. in addition, the patient also denied any headaches, chest pain, shortness of breath or diarrhea. the patient had previously been at home until two weeks to admission when she was transferred to a rehabilitation for wound care in the setting of a right groin hematoma. in the emergency department the patient was assessed by the transplant surgery team and it was noted that the patient had a right groin abscess at the site of her av graft. the patient then underwent removal of the av graft and evacuation of the infected hematoma. prior to procedure the patient was given 2 units of fresh frozen platelets and was given a dose of vancomycin and gentamycin. the patient's oral anticoagulation was also discontinued at this time. on hospital day number two the patient was transferred to the medicine service for further evaluation. past medical history: 1. end stage renal disease secondary to diabetes mellitus. 2. insulin dependent diabetes mellitus. 3. status post right ak in . 4. hypertension. 5. right femoral av graft. 6. colectomy in . medications on admission: 1. insulin of unspecified dose. 2. nephrocaps one tab po q.d. 3. renagel. 4. coumadin 1.5 mg tabs po q.d. 5. phos-lo. 6. lopressor 50 mg po at hemodialysis. 7. prevacid q.d. 8. lisinopril 40 mg po on nonhemodialysis days. 9. zoloft 100 mg po q.d. allergies: penicillin, kefzol. social history: the patient has been residing for two weeks at st. nursing home. the patient denies any tobacco history. family history: noncontributory. physical examination on admission: temperature 101.8. heart rate 97. blood pressure 147/37. respiratory rate 26. the patient was sating at 92% on a nonrebreather face mask. in general, the patient was noted to be lethargic, though arousable and alert and oriented times three. heent was within normal limits except for palpable right parotid gland. neck examination was unable to assess jvp secondary to body habits. cardiac examination revealed s1 and s2, regular rate and rhythm. there were no murmurs, rubs or gallops appreciated. chest examination was notable for bibasilar crackles. abdomen obese, soft, nontender, nondistended. rectal examination was noted to have good rectal tone in the emergency department. extremities, the patient had a right above the knee amputation and was noted to have a firm right groin mass that was warm with 3 cm eschar and murky fluid that was leaking from around eschar. there was a palpable thrill at the right groin area. no clubbing, cyanosis or edema noted on other extremities. laboratory data on admission: white blood cell count of 11.6, hematocrit 35.7, platelets 324. chem 7 revealed a sodium of 140, potassium 4.4, chloride 95, bicarb 29, bun 20, creatinine 3.6, glucose 171, calcium 10, magnesium 2.1, phosphate 2.9. an alt of 18, ast of 19, amylase of 83, total bilirubin of .4. arterial blood gas on admission was 7.51, pco2 44, po2 of 357. electrocardiogram was noted to be in sinus tachycardia with normal axis and normal intervals and left atrial enlargement. there was no q wave noted, early r wave progression, there is no significant st or t wave changes compared with patient's baseline. chest x-ray was negative for any acute cardiopulmonary process. assessment: the patient is a 64 year-old female with a history of insulin dependent diabetes mellitus, end stage renal disease who was initially managed by the transplant surgery service for evacuation of an infected right hematoma. status post procedure the patient was transferred to the medicine service for further evaluation and management. upon transfer the patient the patient continued to have a decreased mental status, though remained afebrile. prior to transfer the patient's initial blood cultures returned 4 out of 4 positive for gram positive coxae. hospital course: 1. infectious disease: the patient presented with right femoral av graft abscess and status post evacuation of this infected right hematoma. the patient was continued on a vancomycin that was dosed at hemodialysis for levels less then 15. at this time the patient remained afebrile and hemodynamically stable. cat scan of the spine ordered by the transplant service was negative for any evidence of overt infection, soft tissue swelling or abscess. cat scan was notable for diffuse osteophytes throughout several levels of the spine. the patient also underwent a tte given bacteremia. the patient's tte was negative function and any thyroid vegetations. the cultures on were 1 out of 2 positive for gram positive coxae. the remaining blood cultures drawn on revealed no growth to date at the time of discharge. throughout this hospital stay the patient defervesced and had a decreasing white count and remains hemodynamically stable. given the small piece of graft that remains at the av fistula site, the patient will be continued on a course of vancomycin for a six week course of treatment. the patient is to be dosed at hemodialysis for levels less then 15. on hospital day number four the patient also underwent further surgical debridement of the right av femoral fistula site. v.a.c. was placed at this time. the patient was followed by the transplant surgical service throughout the remainder of her hospital stay. the v.a.c. was removed on date of discharge. the patient is to follow up with vascular surgery for further management of the right av femoral site. 2. end stage renal disease: the patient with a history of end stage renal disease requiring hemodialysis three times a week secondary to diabetes mellitus. upon removal of her right femoral av site, the patient underwent a temporary quinton catheter placement by the ir service. however, it was noted during hemodialysis this quinton had poor flow. given this in the setting of repeat positive surveillance blood culture the patient was again taken to the operating room for placement of a temporary tunneled catheter. on the day prior to discharge the patient had the new tunnel dialysis catheter placed. on the day of discharge the patient received hemodialysis achieving good flow through this new line. the patient was also continued on calcium acetate throughout this admission. this was titrated up accordingly. the patient's renagel was discontinued. the patient is to follow up with outpatient hemodialysis on mondays, wednesdays and fridays as per prior regimen. further permanent access in the left femoral site will be determined as status post antibiotic therapy by the transplant surgery service. 3. change in mental status: upon admission the patient was noted to have a decreased mental status. this was likely secondary to patient's bacteremia as well as the narcotic pain medications the patient received on admission. throughout the hospital course the patient was titrated off of her narcotic pain medication and had continued improvement in her mental status. 4. cardiovascular: the patient with no known history of coronary artery disease on admission. however, given her risk factors of diabetes mellitus it was felt by the medicine team that the patient should be continued on an aspirin for primary preventive therapy. however, during this admission the patient continued on high doses of non-steroidal anti-inflammatory medications since aspirin therapy was held given the increased risk of gastrointestinal bleeding. an echocardiogram performed during this admission revealed an ejection fraction of 70%, with no wall motion abnormalities. the patient had been on an ace inhibitor as well as a beta blocker as an outpatient. upon admission the patient's ace inhibitor was discontinued by the transplant surgery service who noted low blood pressures. this ace inhibitor was held throughout the remainder of her hospital stay. the patient then continued on a dose of metoprolol 25 mg po b.i.d. however, given persistent low blood pressures the beta blocker was discontinued during this admission. however, the patient should be reinitiated on her beta blocker therapy for noted persistent hypertension as an outpatient. 5. endocrine: the patient has a history of insulin dependent diabetes mellitus. she was continued on a regular insulin sliding scale throughout this admission. the patient was noted to have good glycemic control throughout this admission. the patient will be discontinued on a regular insulin sliding scale and should have insulin therapy as needed. 6. hematology: upon admission the patient was receiving oral anticoagulation therapy as a preventive measure for graft thrombosis. coumadin was discontinued upon admission. the patient was given one dose of vitamin k for reversal of coagulation procedure in the setting of multiple procedures. the patient had a quick reversal of her inr therapy. there is no indication for reinitiation or anticoagulation at the time of discharge. the patient had a fluctuating hematocrit throughout this admission. the patient had no evidence of any bleeding. iron studies were checked and confirmed the patient's history of chronic anemia and the patient was continued on epogen at hemodialysis throughout this hospital stay. on the day of discharge given the patient's hematocrit of 23.8, she was given 1 unit of packed red blood cells. the patient had no known evidence of bleeding at this time. the patient is to have stools guaiaced prior to discharge. 7. psychiatric: the patient was continued on sertraline for major depressive disorders throughout this admission. the patient remained stable. 8. pain: throughout this admission the patient continued to complain of right sided lower back pain. cat scan on admission was negative for any frank abscess or underlying musculoskeletal disease. the patient was continued on oxycodone, which was titrated to off throughout this admission and non-steroidal anti-inflammatory medication. the patient did continue to complain of this low back pain throughout the majority of her hospital stay. on the day prior to discharge the patient underwent an mri to look for an underlying soft tissue or occult infectious process. the final report of this study remains pending prior to discharge, however, will be reviewed by the medicine team pending discharge. the patient should be continued on ibuprofen 800 mg po t.i.d. with meals prn for pain. on the date of discharge the patient notes marked improvement of her pain. 9. fluids, electrolytes and nutrition: the patient was continued on a diabetic diet, which was tolerated well throughout this hospital stay. the patient's fluid balance appeared euvolemic throughout this hospital stay and was titrated accordingly at hemodialysis. 10. prophylaxis: the patient was continued on lansoprazole given the high dose of non-steroidal anti-inflammatory medications that were given. the patient was also continued on pneumatic boots secondary to deep venous thrombosis prophylaxis particularly given the patient's refusal to participate in physical therapy secondary to pain. 11. access: the patient had peripheral intravenous access and had a placement of the quinton and temporary catheter throughout this admission. there were no complications discharge status: to st. nursing home. discharge condition: stable. discharge diagnoses: 1. femoral av graft abscess. 2. mrsa bacteremia. 3. end stage renal disease. 4. hypertension. 5. diabetes mellitus. 6. lower back pain. 7. anemia of chronic disease. 8. depression. discharge medications: 1. sertraline 100 mg po q.d. 2. phos-lo two tabs q.d with meals. 3. nephrocaps one tab po q.d. 4. lansoprazole. 5. regular insulin sliding scale. 6. ibuprofen 800 mg po t.i.d. prn. 7. vancomycin 1 gram to be dosed at hemodialysis for a level less then 15. discharge instructions: 1. the patient is to undergo hemodialysis as previously scheduled as her outpatient regimen. 2. the patient is to follow up with transplant surgery on thursday at 1:00 p.m. for further evaluation and management of right femoral av graft abscess. , m.d. dictated by: medquist36 procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue removal of arteriovenous shunt for renal dialysis application of pressure dressing diagnoses: anemia in chronic kidney disease cellulitis and abscess of trunk infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease major depressive affective disorder, single episode, unspecified infection and inflammatory reaction due to other vascular device, implant, and graft other complications due to renal dialysis device, implant, and graft diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to