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: no drug allergy information on file attending: chief complaint: abdominal pain, diarrhea, hypotension major surgical or invasive procedure: arterial line placement history of present illness: 69f with dm, cad, pvd, htn, multiple mis (most recently ), and af recently hospitalized for treatment of bilateral heel ulcers, now transferred to for abdominal pain, guaaic positive stool and hypotension sbp 80s. per notes, pt was in usoh at rehab when noted to have decreased uop last 3 days (<120ml last 24 hours). she had episode of cp 4-5 days ago for which cxr was obtained which revealed mild pulmonary edema. this was being treated with lasix iv with uptrending cr 2.3->2.7. ngt also placed for tfs approx 4 days ago for decreased po intake (albumin 1.7) and she was subsequently noted to have n/v/d x 3 days. she was also transfused 2 units for hct 25 and started on fluconazole for funguria. today, she was noted to have guaiac positive stool so was sent to osh for possible gib. of note, she has been on primaxin and xyvox for mrsa and vre in bilateral heel ulcers and was noted to have downtrending plt ?->70k->40k. . at , she was guaiac positive with troponin 0.4 and a positive ua. ct abdomen revealed a distended gallbladder with layering gallstones but no other signs of cholecystitis. sbp 80s so lij was placed and she was started on dopamine and transferred to for management of possible sepsis. she was given 2l ns, ctx 1g, flagyl 500mg, zosyn 3.375giv, vanco 1g. . in the ed, initial vs were: 96.7 100 81/56 20 99%2lnc. she was started on levophed with improvement in sbp to 100s and improved mentation to aaox3. bp 86/47 2 hours after arrival on 0.3mcg/kg/min levophed so neo was added at 2200. she received vancomycin 1g, zofran and 3l ns. surgery was consulted for abdominal pain and recommended serial exams and cx. labs remarkable for pancytopenia with plt 30k, wbc 12k, lactate 4.7, cr 2.6, na 129, hct 30, trop 0.39, inr 1.7 and positive ua. vs prior to transfer:95 99/69 13 94% 2l nc . on the floor, she feels "unwell" but unable to be more specific. reports left sided abd pain, difficulty breathing and endorses recent nausea and dry heaves as well as diarrhea but unable to state how long. denies cough, increased le pain, fever, or chills. past medical history: afib not on coumadin for unclear reasons stage 3 pvd htn morbid obesity iddm cad s/p cabg , cath and nstemi chronic vre and mrsa heel ulcers tx with primaxin and zyvox vre uti peripheral neuropathy hyperlipidemia . past surgical history: hysterectomy, iridectomy bilaterally, laminectomy, cabg , rca stent ? social history: lives in ma with her husband prior to stays at rehab. has one daughter (a nurse) who is her proxy. denies e/t/d. family history: unable to obtain physical exam: vitals: t:96.5 bp:80s/60s p:90s r:26 o2:94% 4l general: awake, somnolent but arousable, oriented to self, city, state, month, year, not date or hospital heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp 10cm, lij, picc r arm, no lad lungs: anterior wheezes with bibasilar crackles cv: irreg irreg. distant. normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, obese, hypoactive bs, mildly ttp ruq, llq, luq. no rebound tenderness or guarding, no cvat, no organomegaly gu: no foley ext: cool, dopplerable pulses, +anasarca, r and l heel ulcer with necrotic debris and exposed bone. no purulent exudate, mild erythema. pertinent results: initial labs glucose-154* urean-60* creat-2.6* na-129* k-4.3 cl-95* hco3-19* angap-19 pt-18.7* ptt-36.9* inr(pt)-1.7* wbc-12.7* rbc-3.44* hgb-9.9* hct-30.2* mcv-88 mch-28.8 mchc-32.8 rdw-17.9* neuts-79* bands-1 lymphs-13* monos-7 eos-0 baso-0 atyps-0 metas-0 myelos-0 plt ct-59* ret aut-1.1* lactate-4.7* cortsol-50.3* albumin-2.4* calcium-7.2* phos-4.8* mg-2.2 iron-147 probnp-* ctropnt-0.39* alt-4 ast-14 ld(ldh)-222 alkphos-227* totbili-0.4 dirbili-0.2 indbili-0.2 4am labs lactate-10.4* art temp-35.8 o2 flow-4 po2-135* pco2-27* ph-7.19* caltco2-11* glucose-89 urean-61* creat-2.7* na-130* k-4.6 cl-98 hco3-10* angap-27* wbc-12.2* rbc-3.53* hgb-10.2* hct-31.7* mcv-90 mch-28.8 mchc-32.1 rdw-17.7* plt ct-42* imaging cxr:picc, left ij catheters in appropriate position. ngt tip not clearly seen. bibasilar effusions and atelectasis. limited study. ruq u/s:impression: 1. limited examination. cholelithiasis, but no evidence for cholecystitis. ecg:atrial fibrillation. intraventricular conduction delay. no previous tracing available for comparison. micro data: urine cx: urine culture (preliminary): yeast. >100,000 organisms/ml.. gram negative rod(s). 10,000-100,000 organisms/ml.. blood cx ngtd .......... osh imaging osh cxr: no intestinal obstruction. some gaseous distension of stomach. mild chf with vascular congestion. ct abd/pelvis: moderate bilateral effusions, distension of gb, layering stones, no wall thickening, no free air or fluid, diffuse sc edema in chest wall and abdominal wall cxr: loculated r pleural effusion/pleural thickening at r base kub: no intestinal obtruction. brief hospital course: 69f with cad s/p cabg and mi x and , htn, pvd, bilateral heel ulcers on impinem and linezolid, and transferred from osh with vasopressor dependent shock, likely multifactorial. #. shock/hypotension: differential diagnosis included septic, hypovolemic, cardiogenic shock. cool extremities and recent cp with pulm edema on cxr and cvp 20-24 most consistent with cardiogenic shock. patient also developed worsening hypoxia and increased o2 requirement which was exacerbated with laying flat. it is possible she had recent mi when c/o cp several days prior or worsening chf related to transfusions received several days prior. dobutamine was attempted for inotropy but hypotension worsened on max levophed and uptitrated neo. she was also treated with dapto/po vanco/zosyn/fluconazole for possible infectious sources such as skin/osteo given heel ulcers which probe to bone, c difficile/colitis with recent diarrhea, uti with positive ua, and line infection with picc in place. lack of leukocytosis and fever argued against infectious cause. guaiac positive stool in the setting of thrombocytopenia make slow gib a possible source of hypotension as well although hct remained stable. uop remained low and pt maxed out on 4 pressors as above with progressive hypotension maps in 40s-50s in addition to altered mental status and hypoxia requiring nonrebreather. her daughter and hcp was called to discuss prognosis and pt was made dnr/dni with focus on comfort care and she expired several hours later. #. hypoxia: likely secondary to pulmonary edema and cardiogenic shock. started on bipap with no improvement. . #. thrombocytopenia: likely related to myelosuppressive effects of linezolid and imipenem +/- sepsis +/- gib/consumptive process. . #. anemia/guaiac positive stool: likely secondary to gib +/- myelosuppression as above. hct stable. #. abdominal pain: most likely secondary to ischemia in setting of poor florward flow but covered for infectoius sources with zosyn as well. ct a/p without contrast did not demonstrate acute pathology. . #. hyponatremia: likely related to volume overload and anasarca as appears total body hypervolemic. . #. on : unclear baseline. likely prerenal secondary to chf and decreased forward flow vs atn from sepsis. urine na<10. . #. heel ulcers: on chronic abx and probe to bone so likely has undergoing osteo. covered with abx as above. # code: full then changed to dnr/dni medications on admission: carvedilol 3.125mg crestor 40mg daily colace 100mg fluconazole 100mg po daily x 1 more day (total 5 days) isosorbide mononitrate cr 30mg daily levemir 100u/ml 10 u q bedtime lisinopril 2.5mg daily meclizine 12.5mg tid novolog 10u q lunchtime and 8u qam reglan 10mg po qid rocephin 1gm iv x 10 days (started empirically ) ranexa 500mg po bid started primaxin 500-500mg iv tid (imipenem-cilastin) zyvox 600mg nystatin powder triple pink cream furosemide 20mg iv x 1 , 40mg iv daily sl nitro prn , vicodin prn zofran prn solumedrol 20mg iv x 1 discharge medications: none discharge disposition: expired discharge diagnosis: cardiogenic shock discharge condition: expired discharge instructions: none followup instructions: none md, procedure: arterial catheterization diagnoses: thrombocytopenia, unspecified abdominal pain, unspecified site congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified nausea with vomiting other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) cardiogenic shock septic shock infection with microorganisms without mention of resistance to multiple drugs morbid obesity chronic systolic heart failure long-term (current) use of anticoagulants calculus of gallbladder without mention of cholecystitis, without mention of obstruction diarrhea methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site hemorrhage of gastrointestinal tract, unspecified unspecified hereditary and idiopathic peripheral neuropathy other and unspecified coagulation defects ulcer of heel and midfoot acute myocardial infarction of unspecified site, subsequent episode of care 

Answer: The patient is high likely exposed to