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: vancomycin / rifampin attending: chief complaint: septic shock and respiratory failure major surgical or invasive procedure: none history of present illness: this is a 70 year old man who was discharged after a 3 month complicated hospitalization who presents with hypotension and respiratory failure. his recent medical problems started after he sustained a c7 vertebral fracture in . he underwent a orif of c6-7 with posterior fusion, laminectomy, and iliac crest bone graft with wire placement in . his course was complicated by a csf leak which was repaired, but then followed by development of mrsa meningitis, cerebritis, sinusitis, and mastoiditis, pe/dvt, nstemi, acute interstitial nephritis and hypersensitivity desquamative dermatitis believed secondary to vancomycin or rifampin, respiratory failure from pneumonia, icu neuropathy/myopathy, candidemia, and mental status changes. . he now presents following an episode of depressed mental status and hypotension at . fluid was given and ems was called. he had an abg of 7.14/74/83 on unknown o2 settings and was found to be satting 91% on nrb mask and have systolic pressures from 40-60, so he was intubated and transported to . his pressures stauyed in the 40-60's and he was started on levophed and fluids. with his hypotension, lactate of 3.8 and wbc 28 with 17% bands, a code sepsis was called. he was given 4l more fluid and a right ij sepsis line was placed with cvp from . urine and blood cultures were drawn. he was transferred to the micu. past medical history: 1. diabetes mellitus type ii uncontrolled w/ complications 2. coronary artery disease s/p cabg x 3 3. hypertension 4. anxiety 5. hypercholesterolemia 6. l3-l4 surgery 7. bph 8. recent hospitalization notable for: traumatic comminuted c7 verterbral fracture orif/laminectomy/instrumentation/posterior fusion csf leak - wound infection s/p drainage and dural repair incision and drainage and hardware exchange mrsa meningitis mrsa pneumonia left heart failure non-st elevation myocardial infarction left occipital stroke vs mrsa cerebritis rle deep venous thrombosis pulmonary embolism non-sustained ventricular tachycardia hypersensitivity desquamative dermatitis (rifampin vs vancomycin) eosinophilia hypoxic respiratory failure septic vs. anaphylactic shock delirium cholestasis rue paresis bilateral lower extremity myopathy dysphagia gi bleed nosocomial lll pneumonia anemia - multifactorial: illness, blood loss, ckd. sacral and heel ulcers mrsa/vre colonization candidemia decub ulcer hep c rp bleed social history: no smoking, etoh or ivda. was plumber. lived with wife until , but was at since c spine fusion, then , then family history: nc physical exam: v: tm 103.5 tc 96 p70 bp 121/44 r12 100% cvp 6-8 vent: ac 450x16 60% p5 pip 21 plat 16 gen: intubated, sedated but appears comforatable heent: pupils reactive bilaterally. ett in place. neck: no jvd resp: clear bilaterally no rhonchi cv: rrr nl s1s2 + wem lusb abd: soft ntnd g tube in place ext: warm, 1+ edema hands, no edema legs back: stage 2 sacral decub ~8 cm neuro: not following commands. pertinent results: 148 114 44 agap=17 -------------< 216 4.5 22 1.8 ca: 8.0 mg: 1.6 p: 6.0 d 96 27.9 \ 7.7 / 461 / 26.1\ n:80 band:17 l:1 m:2 e:0 bas:0 pt: 29.5 ptt: 51.6 inr: 3.1 05:46am blood wbc-6.8 rbc-3.25* hgb-9.2* hct-28.8* mcv-89 mch-28.5 mchc-32.1 rdw-18.0* plt ct-309 06:00am blood neuts-60.0 bands-0 lymphs-24.3 monos-6.2 eos-9.0* baso-0.6 05:46am blood plt ct-309 05:46am blood glucose-130* urean-31* creat-1.3* na-145 k-3.6 cl-116* hco3-21* angap-12 09:43pm blood ck(cpk)-42 09:43pm blood ck-mb-notdone ctropnt-0.07* 03:25pm blood ck-mb-notdone ctropnt-0.09* 07:57am blood ck-mb-notdone ctropnt-0.12* 04:57am blood cortsol-23.2* 07:57am blood cortsol-31.2* 08:30am blood cortsol-33.5* 04:12am blood triglyc-168* hdl-27 chol/hd-3.6 ldlcalc-37 05:58am blood type-art po2-83* pco2-35 ph-7.39 calhco3-22 base xs--2 09:18am blood lactate-1.1 08:45pm blood o2 sat-80 micro blood culture aerobic bottle-pending; anaerobic bottle-pending inpatient blood culture aerobic bottle-pending; anaerobic bottle-pending inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient catheter tip-iv wound culture-final {pseudomonas aeruginosa} inpatient wound culture (final ): pseudomonas aeruginosa. >15 colonies. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 2 s meropenem-------------<=0.25 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r sputum gram stain-final; respiratory culture-final {pseudomonas aeruginosa} inpatient pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 4 s meropenem------------- 0.5 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r urine urine culture-final {pseudomonas aeruginosa, 2nd isolate} inpatient pseudomonas aeruginosa | cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 4 s meropenem-------------<=0.25 s piperacillin---------- 8 s piperacillin/tazo----- <=4 s tobramycin------------ =>16 r blood culture aerobic bottle-pending; anaerobic bottle-pending emergency blood culture aerobic bottle-pending; anaerobic bottle-pending cardiology report echo study date of conclusions: 1. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. 2. the left ventricular cavity size is normal. overall left ventricular systolic function cannot be reliably assessed. 3. the mitral valve leaflets are mildly thickened. 4. compared with the prior study (images reviewed) of , there is no significant change. liver or gallbladder us (single organ) port 1:50 pm conclusion: negative right upper quadrant ultrasound. chest (portable ap) 7:08 am impression: 1. slight improvement of a longstanding left retrocardiac atelectasis (less likely pneumonia) and associated effusion. 2. new right ij catheter without pneumothorax. mr w& w/o contrast 3:50 am impression: no evidence of new fluid collection seen or an area of new enhancement identified. focal increased signal seen within the spinal cord at c7 level which could be secondary to myelomalacia. no evidence of discitis or osteomyelitis. continued mild increased signal within the posterior soft tissues at the laminectomy site could be due to inflammatory changes without evidence of focal fluid collection. brief hospital course: 1) septic shock with respiratory failure from pseudomonas line infection - pt was hypoxic and hypotensive on presentation and intubated in the field. with elevated lactate, wbc, and respiratory failure, this represented septic shock. the potential sources were recurrence of meningitis/cervical fluid abscess, uti, c dif given antibiotic use, picc line infection, persistent candidemia, sacral decub inflammaion. he received 1 dose vancomycin in the ed and levo/flagyl, but on admission to the micu was changed to linezolid and cefepime to add pseudomonas coverage. he was continued on voriconazole for history of blood infection. his picc line was pulled. he got >10 liters of fluid and svo2 was >90% despite fluids, so an echo was done which showed no shunt. after 2 days, he was weaned from levophedrine then extubated with improvement in svo2 to the 80's. id was consulted and recommended continuing linezolid and cefepime, and obtaining mri of the neck area which showed no drainable fluid collection. his previous neck surgeon was consulted and found no signs of infection in the neck area, so the decision was jointly made not to perform lp. the next day, cultures revealed pseudomonas sensitive to cefepime. he continued to do well and was afebrile. he will be continued on cefepime for 14 days total, and doxacycline indefinitely for mrsa prophylaxis. he should have follow up with id. 2) sacral decub - wound care was consulted and noted that his sacral decub ulcer had a black thick eschar on sacral decub 9x13 cm, increased from 2-3 cm on last discharge. plastic surgery felt not need for surgical interventions. copntinue care as directed. 3) ekg changes/demand ischemia - the patient was noted to have new inferior flipped t waves on admission, and slightly elevated troponins in the setting of systolic blood pressures to the 40's. this was felt to be demand ischemia, as he has a previous history of cabg. he should follow up with his cardiologist and stress test or cath should be considered when his rehabilitation is completed. he was continued on aspirin, and beta blocker and captopril were restarted when blood pressure tolerated. 4) vancomycin allergy with eosinophilia - the patient had a history of severe desquamative reaction/ain/hypotension and fevers in recent hospitalization to vanco/rifampin. he received a dose of vancomycin in ed and developed eosinophila, but no evidence of rash or kidney failure. urine eos were negative. 5) acute renal failure - he had acute renal failure likely secondary to sepsis, but fena 3.67 so likely had some atn in addition to prerenal component. his creatinine improved with hydration to baseline. 6) history of pe/dvt, on anticoagulation - he was reversed on admission with 1 mg iv vitamin k in anticipation of possible lp, but then started on heparin when inr was < 2. he was restarted on coumadin 5 mg po qd on the evening of . currently dose 2.5 mg/qhs. goal 2-3mg 7) hypernatremia: increase sodium on . likely lack of free water intake. currently getting 250 free water qid. na trending down. 8) code status - his code status was extensively discussed with his family on admission given his poor prognosis. he was initially "do not shock, no cpr" but this was changed back to full code after personal phone call from daugter morning of . medications on admission: acetaminophen 325 mg po q4-6h aspirin 325 mg po daily nystatin 100,000 unit/g cream topical zinc oxide-cod liver oil 40 % ointment mupirocin calcium 2 % cream topical albuterol sulfate 0.083 % solution q2h as needed. ipratropium bromide 0.02 % solution inhalation q6h (every 6 hours) as needed. sodium chloride sprays nasal tid (3 times a day). amlodipine 10 mg po daily hydrochlorothiazide 25 mg po daily lansoprazole 30 mg po daily metoprolol tartrate 100 mg po tid folic acid 1 mg po daily epoetin alfa 10,000 unit/ml qmowefr (monday -wednesday-friday). doxycycline hyclate 100 mg po q12h (every 12 hours). captopril 25 mg po tid voriconazole 200 mg intravenous q12h through insulin sliding scale heparin sliding scale coumadin since linezolid started at 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 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 7. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours): to be continued indefinitely for mrsa prophylaxis. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day): may titrate as tolerated to keep pulse around 60. 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. epoetin alfa 10,000 unit/ml solution sig: () units sq injection qmowefr (monday -wednesday-friday). 11. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 12. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. captopril 25 mg tablet sig: one (1) tablet po tid (3 times a day): may titrate to keep systolic blood pressure between 120 and 140. 14. warfarin 5 mg tablet sig: 0.5 tablet po hs (at bedtime): adjust as needed, goal inr . . 15. insulin regular human subcutaneous 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po once (once) for 1 doses. 17. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 18. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. 19. cefepime 2 g piggyback sig: two (2) grams intravenous q12h (every 12 hours) for 8 days: last day . then please dc picc line. 20. free water please give 250 freww water qid through g tube. follow up sodium closely discharge disposition: extended care facility: & rehab center - discharge diagnosis: pseudomonal line septic shock with urine and sputum colonization respiratory failure vancomycin allergy acute renal failure discharge condition: good discharge instructions: contineu your medications as prescribed if you have hypotension, fevers, respiratory distress or other concerns, please return to the ed. followup instructions: please follow up with your pcp, , . , 1 week after discharge from rehab. please follow up with your surgeon, dr. , 1 week after discharge from rehab. please follow up with your cardiologist in months regarding the need for stress testing. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization injection or infusion of oxazolidinone class of antibiotics diagnoses: urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status acute respiratory failure septic shock pressure ulcer, lower back infection and inflammatory reaction due to other vascular device, implant, and graft hyperosmolality and/or hypernatremia septicemia due to pseudomonas 

Answer: The patient is high likely exposed to