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: ativan attending: chief complaint: dyspnea major surgical or invasive procedure: central venous line placement history of present illness: for a full admission note, please see micu green note. in brief, this is a 53 year old woman with pmh significant for t1-t2 paraplegia s/p mvc, recurrent uti/pna, chronically on 2l of oxygen at home, and anxiety who presented to hospital with shortness of breath and fevers. . caretaker noted her to be breathing faster than normal prior to admission. she also reports recent dysphagia, concerning for aspiration pneumonia. at home does intermittently straight-cath, however she is unable to discern signs/sx of uti. per care taker, she was seen by dr several weeks again found to have +ua however no definite culture data so not treated. . in the ed she was found to have temp of 100.7 with o2 sat at 84% on 2l (baseline in low 90s) and sbp in 90s. her wbc count was elevated and ua found to be positive. she got 2 l of fluid and was transferred to the micu. of note, she had a picc line on admission. . while in the micu, she started treatment for uti with vanc and given hx of . she had a cxr that could not exclude pneumonia. she was also on levaquin for 3 days for legionella coverage but this was stopped on when found to be negative. she has been getting chest pt and nebs and also reports some cough. sputum culture growing coagulase positive staph and gram negative rods. she had 1 positive blood cx for coag negative staph and picc line was pulled. . prior to transfer to the floor her blood pressure was in low 100s, she was mentating well and had no active complaints. past medical history: #t1 to t2 paraplegia status post a motor vehicle accident. #recurrent pneumonia (followed by pulm - last ) - per pulm, recurrent pneumonia likely from pulmonary toilet issues secondary to neuromuscular disease with improvement with consistent and aggressive bronchopulmonary therapy. - prior sputum cultures + for mrsa, pan-sensitive klebsiella, and pseudomonas. #recurrent utis in the setting of urinary retention requiring straight catheterization #copd #hx pres syndrome #hepatitis c #anxiety #dvt in -ivc filter placed in #pulmonary nodules #hypothyroidism #chronic pain #chronic gastritis #anemia of chronic disease #s/p pea arrest during hospitalization in social history: lives at home with husband and 2 adolescent children. - tobacco: 35-pack-years, quit several months ago, relapsed recently. - alcohol: denies. - illicits: denies. family history: mother passed away with lung disease. physical exam: physical exam on arrival to the micu vs: tmax: 37.1 ??????c (98.7 ??????f) tcurrent: 36 ??????c (96.8 ??????f) hr: 65 (62 - 80) bpm bp: 83/47(55) {83/45(55) - 93/74(77)} mmhg rr: 17 (12 - 23) insp/min spo2: 99% general: alert, oriented, agitated heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, mildly distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam vs 96.9 117/72 79 20 97% 2l general: alert, oriented heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp difficult to assess, no lad lungs: few bibasilar crackles. good aeration cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, bowel sounds present, no rebound tenderness or guarding gu: + foley, no suprapubic tenderness ext: warm, well perfused, 1+ le edema halfway up shins. 2+ dp pulses pertinent results: 10:50am blood wbc-11.7*# rbc-3.51* hgb-9.6* hct-30.5* mcv-87 mch-27.2 mchc-31.4 rdw-14.8 plt ct-192 10:50am blood neuts-92.8* lymphs-5.0* monos-1.3* eos-0.6 baso-0.3 10:50am blood glucose-141* urean-9 creat-0.4 na-140 k-4.2 cl-100 hco3-32 angap-12 03:35am blood calcium-8.3* phos-2.9 mg-1.8 11:02am blood lactate-2.3* 03:52am blood type- po2-74* pco2-75* ph-7.26* caltco2-35* base xs-3 comment-green top 03:52am blood lactate-1.3 07:51am blood type- po2-47* pco2-87* ph-7.24* caltco2-39* base xs-6 12:18pm blood type- po2-96 pco2-73* ph-7.28* caltco2-36* base xs-4 comment-green top 07:51am blood lactate-0.8 . micro: **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | amikacin-------------- =>64 r ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- 8 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- 256 r tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): multiple organisms consistent with oropharyngeal flora. smear reviewed; results confirmed. respiratory culture (final ): commensal respiratory flora absent. 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. klebsiella pneumoniae. sparse growth. piperacillin/tazobactam sensitivity testing available on request. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | klebsiella pneumoniae | | amikacin-------------- =>64 r ampicillin/sulbactam-- 8 s cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- 8 r ciprofloxacin--------- =>4 r clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s =>16 r levofloxacin---------- =>8 r meropenem------------- <=0.25 s oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ =>16 r trimethoprim/sulfa---- <=0.5 s 2 s vancomycin------------ 1 s cxr chest, ap and lateral: patient was unable to raise her arms for the lateral view, on which bilateral humeral fixation plates and screws obscure evaluation. left internal jugular catheter has been removed. right picc again terminates in the mid svc. there is no pneumothorax. the lungs are overinflated. moderate cardiomegaly persists, with vascular congestion and small bilateral pleural effusions. lower lobe opacities persist, left greater than right. there are old healed bilateral rib fractures, with associated chest wall deformity. impression: 1. chronic obstructive airways disease. 2. congestive heart failure. 3. bilateral lower lobe opacities may be secondary to #2, but superimposed pneumonia is not excluded. echo the left atrium is elongated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: suboptimal study. normal global biventricular systolic function. mild pulmonary hypertension. very small pericardial effusion. . video swallow study penetration and aspiration with thin liquids. chin tuck helps to limit aspiration with thin liquids. penetration with nectar-thick liquids. for details, please refer to speech and swallow division note in omr. . discharge labs 05:50am blood wbc-4.9 rbc-3.12* hgb-8.3* hct-27.2* mcv-87 mch-26.5* mchc-30.4* rdw-14.6 plt ct-216 05:50am blood glucose-81 urean-5* creat-0.2* na-145 k-4.0 cl-102 hco3-40* angap-7* 05:50am blood calcium-8.8 phos-3.5 mg-2.0 brief hospital course: 53f t1-t2 paraplegia s/p mvc, recurrent uti/pna, and anxiety who is presented with sob and fever initially admitted to the micu found to have uti and pneumonia which improved with antibiotic treatment. . # uti - urine cx showed multi-drug resistant klebsiella (only sensitive to meropenem and cefepime). patient started on meropenem. picc line placement was unsuccessful and tunneled line was placed. patient discharged with plans to complete total 10 day course of antibiotics. . # pneumonia - patient presented with sob, fever, and increased o2 requirement. cxr showed r pleural effusion and could not exclude pneumonia. also given dysphagia concern for aspiration. pleural effusion thought to be parapneumonic vs to heart failure (cxr also showed enlarged heart). echo was done and showed normal ef. component of sob/hypoxia also thought to be secondary to hypoventilation from underlying paraplegia. sputum cultures grew mrsa and klebsiella. patient was treated with vancomycin, meropenum, levofloxacin, nebulizers and chest pt while in the micu. levofloxacin was discontinued prior to transfer to the floor after urine legionella was found to be negative. given difficult access, a tunneled line was eventually placed after failed picc attempts. patient clinically improved and oxygen requirement returned to baseline 2l. patient was discharged with plans to complete total 10 day course of iv antibiotics. . # hypotension. patient initially presented with sbp in the 90s. she was given 3l in the ed. bp remained stable in the micu and on the floor after fluid resuscitation. . # dysphagia. - followed by as outpatient. symptoms are thought to be related to dysphagia for solid foods, although there is some question whether there may be over spill into the larynx as well. previous endoscopy demonstrated some mild changes in the esophagus, but no obvious stricture; it is possible in the interim she has developed a stricture as pt with h/o tracheostomy. also note of possible esophageal mass on ct, although very small in size. s&s recommended regular diet with thin liquid and video swallow study. video swallow study was completed which showed penetration and aspiration with thin liquids. chin tuck helped to limit aspiration with thin liquids. also showed penetration with nectar-thick liquids. recommendations included thin liquids and moist solids, pills with puree, and aspiration precautions. patient has plans to follow up with outpatient gastroenterologist for further evaluation and treatment. . # depression/anxiety - continued clonazepam, citalopram, trazodone . # hypothyroid - continued levothyroxine . # chronic pain - continued baclofen, lyrica, methadone, lidocaine patches. also was given oxycodone prn. . transitional issues - complete antibiotics as prescribed - tunneled line will need to be removed after completion of treatment - hco3 will need to be rechecked as was slightly elevated upon discharge - patient was full code on this admission medications on admission: albuterol sulfate - 2.5 mg/3 ml (0.083 %) solution for nebulization - one vial inh 4-6 hours prn baclofen - 10 mg tablet - 2 (two) tablet(s) by mouth in the morning; 1 (one) tablet at 4 pm and 2 (two) tablets at bedtime citalopram - 20 mg tablet - 2 tablet(s) by mouth once a day clonazepam - 0.5 mg tablet - 2 tablet(s) by mouth (1 mg) three times a day estradiol - 0.01 % cream - apply to exterrnal gyn area twice a week ipratropium-albuterol - 18 mcg-103 mcg (90 mcg)/actuation aerosol - 2 puffs three times a day levothyroxine - 112 mcg tablet - 1 (one) tablet(s) by mouth once a day lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply four patches to the affected areas once a day 12 hours off and 12 hours on - no substitution lidocaine hcl - 5 % ointment - apply externally to affected area once a day as needed for burning methadone - 5 mg tablet - 1 tablet(s) by mouth three times daily for pain methenamine hippurate - 1 gram tablet - 1 tablet(s) by mouth twice a day take with vitamin c 500 omeprazole - 20 mg capsule, delayed release(e.c.) - one capsule(s) by mouth twice a day oxybutynin chloride - 5 mg tablet - 2 tablet(s) by mouth in the am, one in the afternoon, and 2 in the evening oxycodone - 5 mg tablet - 1 tablet(s) by mouth three times a day as needed for pain pregabalin - 100 mg capsule - 1 capsule(s) by mouth three times a day simvastatin - 10 mg tablet - 1 tablet(s) by mouth daily sucralfate - (post d/c med) (on hold from to for while taking levaquin) - 1 gram tablet - 1 tablet(s) by mouth four times a day trazodone - 100 mg tablet - 1 tablet(s) by mouth at bedtime . medications - otc calcium carbonate - (prescribed by other provider) (on hold from to for while taking levaquin) - 500 mg (1,250 mg) tablet - 1 tablet(s) by mouth twice daily pt unsure if 500mg or 600mg catheter - 14 fr - use for urinary control/self catheterizaion as needed dx: neurogenic bladder, paraplegia (1 month supply) facial-body wipes - - use as directed prn nebulizer - kit - for use in home qd. dx: pneumonia nicotine - (prescribed by other provider) (not taking as prescribed) - 21 mg/24 hour patch 24 hr - apply 1 patch daily as directed polyethylene glycol 3350 - (not taking as prescribed: not on medication list provided by patient ) - 17 gram (100 %) powder in packet - one pack by mouth once a day surgical lubricant jelly - gel - as needed for straight cath discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) vial inhalation q6h (every 6 hours) as needed for sob. 2. baclofen 10 mg tablet : two (2) tablet po bid (2 times a day). 3. citalopram 20 mg tablet : two (2) tablet po daily (daily). 4. clonazepam 0.5 mg tablet : two (2) tablet po three times a day. 5. vancomycin in d5w 1 gram/200 ml piggyback : one (1) gram intravenous q 12h (every 12 hours) for 5 days: continue until . . disp:*10 gram* refills:*0* 6. meropenem 1 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours) for 5 days: continue through . disp:*qs recon soln(s)* refills:*0* 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily): apply four patches to the affected areas once a day 12 hours off and 12 hours on - no substitution . 8. levothyroxine 112 mcg tablet : one (1) tablet po daily (daily). 9. combivent 18-103 mcg/actuation aerosol inhalation 10. methadone 5 mg tablet : one (1) tablet po tid (3 times a day). 11. oxycodone 5 mg tablet : one (1) tablet po three times a day as needed for pain. 12. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po bid (2 times a day). 13. pregabalin 100 mg capsule : one (1) capsule po tid (3 times a day). 14. simvastatin 10 mg tablet : one (1) tablet po daily (daily). 15. trazodone 100 mg tablet : one (1) tablet po at bedtime. 16. outpatient lab work please check cbc, chem 7, vancomycin trough level on and fax results to dr. fax#:. 17. outpatient lab work please check cbc, chem 7, on and fax results to dr. fax#:. 18. estradiol 0.01 % (0.1 mg/g) cream : as directed mg vaginal twice weekly: apply to external gyn area twice a week . 19. lidocaine 5 % cream : as directed cream topical once a day as needed for pain: apply externally to affected area once a day as needed for burning . 20. methenamine hippurate 1 gram tablet : one (1) tablet po twice a day: take with vitamin c 500 . 21. oxybutynin chloride 5 mg tablet : as directed tablet po as directed: 2 tablet(s) by mouth in the am, one in the afternoon, and 2 in the evening . discharge disposition: home with service facility: vna discharge diagnosis: 1)pneumonia 2)urinary tract infection discharge condition: activity status: out of bed with assistance to chair or wheelchair. level of consciousness: alert and interactive. mental status: clear and coherent. discharge instructions: dear ms. , you were admitted to our hospital with a concern for a urinary tract infection and pneumonia. we had trouble obtaining intravenous access to administer antibiotics, and finally established it. you will need to have the catheter in for administration of intravenous antibiotics for a total of 5 more days. after that you will need to have the catheter removed. please keep the catheter site dry and intact. the following changes were made to your medication regimen: start vancomycin start meropenem followup instructions: department: digestive disease center when: wednesday at 1 pm with: ,md building: building (/ complex) campus: east best parking: main garage department: endo suites when: wednesday at 1 pm department: when: wednesday at 9:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: central venous catheter placement with guidance diagnoses: anemia of other chronic disease other chronic pain urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site chronic hepatitis c without mention of hepatic coma chronic airway obstruction, not elsewhere classified dysthymic disorder alkalosis personal history of venous thrombosis and embolism paraplegia tracheostomy status other respiratory abnormalities atrophic gastritis, without mention of hemorrhage personal history of sudden cardiac arrest late effect of spinal cord injury late effects of motor vehicle accident dysphagia, oropharyngeal phase methicillin resistant pneumonia due to staphylococcus aureus unspecified disorder of metabolism unspecified disorder of esophagus 

Answer: The patient is high likely exposed to