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 83-year-old male with a recent prolonged hospitalization for abdominal aortic aneurysm on which was complicated by delayed primary closure of the abdominal wound and aspiration which led to a percutaneous endoscopic gastrostomy tube placement. initially, he also had respiratory failure with a prolonged intubation, methicillin-resistant staphylococcus aureus and a pseudomonas pneumonia, pancytopenia (thought secondary to medications), and hypernatremia. the patient was transferred from rehabilitation with a fever to 103, change in mental status, and leukopenia to 1.4 (with 21% bands). his sodium was increased to 158, blood urea nitrogen was 124, and creatinine was 5.3. the patient was empirically given vancomycin and ceftazidime at the outside rehabilitation facility and transferred to the emergency room. in the emergency room, the patient was hypotensive which responded initially to fluid resuscitation. in the emergency room, an arterial line and left subclavian line were placed for hemodynamic monitoring. the vascular surgery admitted the patient to the intensive care unit with a diagnosis of sepsis. past medical history: (the patient's past medical history is significant for the following) 1. methicillin-resistant staphylococcus aureus pneumonia. 2. pseudomonas pneumonia. 3. retro abdominal aortic aneurysm; status post open repair; status post percutaneous endoscopic gastrostomy tube placement; aspiration. 4. history of hypernatremia. 5. chronic renal insufficiency. 6. history of right empyema; status post thoracotomy. medications on transfer: 1. epogen 3000 units three times per week. 2. prevacid 30 mg by mouth once per day. 3. lopressor 25 mg by mouth twice per day. physical examination on presentation: his vital signs on admission were temperature of 99, heart rate was 120, blood pressure was 80/40, respiratory rate was 30, and he was saturating 83% on room air. on examination, the patient was alert to person only. his mucous membranes were dry. he had bilateral wheezes and coarse breath sounds. he was tachycardic. his abdomen was soft and nontender. he had trace pedal pulses. his skin was warm. pertinent radiology/imaging: his electrocardiogram showed sinus tachycardia at 119 with left axis deviation, and no acute st-t wave changes. his chest x-ray showed a right pleural effusion and was essentially unchanged. laboratories on presentation: his white blood cell count was 2.7, hematocrit was 27.4, and platelets were 104. his urinalysis showed large blood and trace protein. his lactate was 5.1. concise summary of hospital course by issue/system: 1. neurologic issues: the patient was sedated for intubation initially; however, suffered no acute neurological events. on the floor, he was intact neurologically with no focal deficits. he remained somewhat confused; however, he remained alert to person and place. 2. respiratory issues: the patient was admitted with a diagnosis of sepsis with a presumed pulmonary source. this was likely due to his aspiration risk; although, the patient was being fed through his percutaneous endoscopic gastrostomy tube at the rehabilitation facility. initially, on his sputum specimen from , he grew out methicillin-resistant staphylococcus aureus and a pan-sensitive pseudomonas. subsequently, a separate sputum specimen sent on grew out a multiresistant escherichia coli and klebsiella organisms. the patient was started initially triple antibiotic therapy for this and responded well as far as his fever and pulmonary function was concerned. he was extubated in the intensive care unit and eventually transferred to the floor. however, he decompensated on the floor and became hypotensive and febrile with increasing pulmonary secretions and was transferred back to the intensive care unit on where sputum cultures again grew out multiresistant organisms. he has subsequently been a 2-week course of meropenem and flagyl which the organisms were susceptible to, and this course is being completed today (on the day of discharge). the patient was oxygenating well with humidified room air. he did get a tracheostomy to facilitate weaning and pulmonary toilet during his second intubation. this was done on . he continues to have significant thin secretions; however, he is able to bring this up on his own and he is easily suctioned. the patient requires deep suctioning rarely; approximately once per day. 2. cardiovascular issues: cardiovascular wise, the patient was initially hypotensive on admission which was treated with fluid resuscitation and a brief administration of beta pressors. throughout the patient's convalescent therapy, he has been hemodynamically stable. he has had no episodes of cardiac ischemia or chest pain. during the patient's second intensive care unit admission, he developed atrial fibrillation which was treated with amiodarone loading intravenously which he responded to and then converted to a sinus rhythm. this was transitioned to by mouth amiodarone, and he is now on a dose of 400 mg by mouth once per day. he remains in a sinus rhythm on discharge. 3. genitourinary issues: the patient was admitted with a creatinine of over 5 which was an exacerbation of his chronic renal insufficiency and due to the hypotension and sepsis. the patient has now proceeded to end-stage renal failure. he has received a tunnelled right internal jugular dialysis catheter and is undergoing hemodialysis on tuesday, thursday, and saturday which he is tolerating. 4. gastrointestinal issues: the patient failed several swallowing studies and receives goal calories through his percutaneous endoscopic gastrostomy tube which was placed during his prior admission. currently, he is getting nepro at 45 cc per hour at full strength. 5. infectious disease issues: again, the patient had a polymicrobial/multiresistant pneumonia which is the etiology of his sepsis on admission and his subsequent deterioration midway in his hospital course, which has been treated adequately with appropriate antibiotics. currently, the patient has been afebrile and his white count is 5. his antibiotics will be discontinued today. of note, the patient was also clostridium difficile positive on initial presentation and has received flagyl for the entirety of his hospital course, which is being stopped today. condition at discharge: his discharge status is stable. his overall condition is good. he is alert and oriented times two. he follows commands and is communicative. his heart is regular in rate and rhythm. his lungs have scattered rhonchi. the abdomen is soft and nontender. his extremities were warm and well perfused. discharge diagnoses: 1. sepsis. 2. polymicrobial/multiresistant pneumonia. 3. prolonged ventilation requiring tracheostomy. 4. status post percutaneous endoscopic gastrostomy tube on . 5. chronic renal failure. 6. hemodialysis initiation. 7. status post right internal jugular tunneled dialysis catheter placement. 8. swallowing dysfunction. 9. clostridium difficile infection. secondary discharge diagnoses: 1. history of retro abdominal aortic aneurysm repair on . 2. status post percutaneous endoscopic gastrostomy tube. 3. remote history of right empyema; status post thoracotomy. medications on discharge: (discharge medications include) 1. prevacid oral suspension 30 mg per peg tube once per day. 2. amiodarone 400 mg by mouth every day. 3. metoprolol 25 mg by mouth twice per day. 4. hydromorphone 2 mg to 4 mg by mouth q.3-4h. as needed. 5. subcutaneous heparin 5000 units q.12h. 6. alteplase 4 cc intravenously 2 cc in each hemodialysis catheter port after hemodialysis. 7. haldol 10 mg intravenously three times per day as needed. 8. nephrocaps one tablet by mouth every day. 9. miconazole powder 2% as needed (around percutaneous endoscopic gastrostomy tube). 10. atrovent 1 nebulizer q.6h. 11. albuterol 1 nebulizer q.6h. 12. nystatin oral suspension 5 ml by mouth four times per day as needed. 13. regular insulin sliding-scale as follows; for glucose of 121 to 160 give 2 units subcutaneously; for glucose levels of 161 to 200 give 4 units subcutaneously; for glucose levels of 201 to 240 give 6 units subcutaneously; for glucose levels of 241 to 280 give 8 units subcutaneously; for glucose levels of 281 to 320 give 10 units subcutaneously; for glucose levels greater than 320 notify medical doctor. he gets blood glucose check q.6h. discharge diet: nepro 45 cc every hour (via peg tube. discharge activity: out of bed to chair, ad lib with assistance. discharge instructions/followup: 1. routine tracheostomy care and assistance with suctioning of pulmonary secretions and deep suctioning as needed. 2. the patient should be followed up by dr. . dr. office can be called at telephone number to arrange for an appointment in the next three to four weeks for followup. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy bronchoscopy through artificial stoma transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified severe sepsis atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile 

Answer: The patient is high likely exposed to