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: latex / penicillins / advair diskus attending: chief complaint: abdominal discomfort major surgical or invasive procedure: aaa/endograft removal, debridement, aorto-iliac bypass history of present illness: 70f w history of endovascular repair of aaa c/b left limb occlusion, s/p l ileofemoral bypass; s/p infected r->l fem/fem bypass, p/w mrsa bacteremia now pod 1 s/p revision of aaa graft. recently discharged from the hospital after a l aka revision , r iliac limb angio , and removal of infected fem/fem graft . she was discharged to rehab on metronidazole for c.diff. she presented to hospital in w sharp diffuse abdominal pain associated with back pain. she stated this pain began earlier in the week and has now become increasingly severe. ct scan at w/ concern for an infected aaa endograft w/ gas around graft. she was started on vancomycin/metronidazole and transferred to , blood cultures were not drawn. she was taken to or and had her abd aortic graft removed and a new rifampin soaked graft placed. pus was noted around the aorta and graft, but there was a clear plane separating the bowel from the retroperitoneum. vancomycin beads were implanted in the surgical bed. she was transferred to the cvicu and quickly weaned off of pressors. past medical history: hypertension diabetes gerd renal insufficiency hypothyroidism c-diff mrsa pneumonia pvd dvt past surgical history: 1. tonsillectomy 2. appendectomy 3. achilles tendon repair 4. exploratory laparotomy - ? ulcerative colitis 5. evar c/b left limb occlusion 6. ileofemoral bypass; left 7. right -> left fem/fem bypass 8. left aka social history: residing in rehab facility prior to admission. no etoh, no illicit substances, 40 pack year smoker quit in ' family history: positive for cancer in her mother, lung disease in three uncles, and rheumatologic disorders in her mother. physical exam: vs: 98.8 hr: 73 bp: 171/76 rr: 20 spo2: 99% gen: nad, alert and oriented x3 card: rrr lungs: cta bilaterlly abd: soft, nt, nd skin: left aka- old stsg intact. some moderate pedal edema left abdominal flank incision. steristrips intact- no signs of infection pulses: fem dp posterior tibial left palp - - - right palp palp dop dop pertinent results: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:00am 9.7 3.27* 9.2* 28.9* 88 28.1 31.8 15.4 448* differential neuts bands lymphs monos eos baso atyps metas 05:00am 84.2* 9.9* 3.7 1.9 0.3 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 05:00am 448* basic coagulation (fibrinogen, dd, tt, reptilase, bt) fibrino 05:30pm 372 or 6 chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:00am 156* 18 0.8 137 3.9 102 27 12 estimated gfr (mdrd calculation) estgfr 03:46am using this1 using this patient's age, gender, and serum creatinine value of 0.8, estimated gfr = 71 if non african-american (ml/min/1.73 m2) estimated gfr = >75 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 05:00am 7 13 249 141* 0.2 other enzymes & bilirubins lipase 01:15pm 12 chemistry totprot albumin globuln calcium phos mg uricacd iron 05:00am 2.2* 8.0* 2.5* 1.5* hematologic caltibc vitb12 folate ferritn trf 05:10am 936* 7.9 02:30am 943* 8.0 source: line-picc pituitary tsh 05:10am 32* 02:30am 33* source: line-picc antibiotics vanco 04:08am 22.7*1 source: line-picc updated reference range as of == represents therapeutic trough lab use only greenhd redhold 05:10am hold blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 pco2 ph caltco2 base xs intubat vent 10:22am art 64* 38 7.38 23 -1 08:30am art 86 36 7.39 23 -2 06:29am art 99 34* 7.38 21 -3 whole blood, miscellaneous chemistry glucose lactate na k cl 08:30am 112* 3.8 06:29am 121* 3.7 hemogloblin fractions ( cooximetry) hgb calchct o2 sat 06:29am 98 calcium freeca 06:29am 1.12 radiology report ct abdomen w/contrast study date of 9:15 pm , fa5 9:15 pm ct abdomen w/contrast; ct pelvis w/contrast clip # reason: r/o abscess. pt febrile. field of view: 36 contrast: optiray amt: 130 medical condition: 70f s/p resection of infected endograft and aorto-right cia bypass graft reason for this examination: r/o abscess. pt febrile. contraindications for iv contrast: none. wet read: ipf tue 11:17 pm no definite drainable fluid collections seen. final report history: 70-year-old woman status post resection of infected endograft and aorto right cia bypass graft. rule out abscess. patient is febrile. technique: ct abdomen and pelvis with iv and oral contrast. coronal and sagittal reformatted images provided. comparison: compared to ct from ct abdomen and pelvis. findings: there are bilateral pleural effusions, with bibasilar atelectasis. there is no pericardial effusion. liver appears grossly within normal limits. the gallbladder is contracted. pancreas, adrenal glands and spleen appear within normal limits. the kidneys enhance symmetrically. there is no evidence of hydronephrosis. kidneys demonstrate nonspecific perinephric stranding, with bilateral extrarenal pelvises, with no evidence of hydronephrosis. there are small low-attenuation lesions within the kidneys, too small to characterize. the stomach, duodenum, and loops of small and large bowel appear within normal limits. there is free fluid. no pathologically enlarged retroperitoneal or mesenteric lymph nodes. no definite drainable fluid collection is seen. ct pelvis: the urinary bladder, uterus, and adnexa appear within normal limits. small amount of free fluid is seen. no drainable fluid collection in the pelvis. loops of small and large bowel appear normal. suprarenal abdominal aorta is within normal limits. infrarenally, there has been removal of previously identified endovascular graft and excision of the native aorta with placement of an aorto-uni-iliac tubular graft anastomosis distal to the right common iliac artery. fluid collections are seen in the left posterior pararenal space, peri-lower aorta graft and also just adjacent to the right iliac graft anastomosis. essentially unchanged from prior of . there is no flow to left internal iliac in keeping with post- surgical anatomy. there is no evidence of contrast extravasation. patient has an inferior vena cava filter. bones and soft tissue: there are no suspicious lytic or sclerotic lesions. there is diffuse anasarca. there are foci of air within the subcutaneous tissue of the anterior abdominal wall on the left, 2:59 and right 2:56, with opacification in the soft tissue at 2:49 on the left, which should be correlated with injections, or possible infection at this site. impression: 1. status post excision of endovascular aorta graft and fem-fem bypass graft, with placement of aorto-uni-iliac tubular graft extending from the infrarenal aorta to the right common iliac artery. 2. fluid collectiona around the graft as before. anasarca. ascites. 3. bilateral pleural effusion with associated atelectasis. 4. small amounts of loculated fluid and air in the subcutaneous tissue abdominal ; maybe due to subcu injections. correlate clinically to exclude a wound infection. the study and the report were reviewed by the staff radiologist. , f 70 radiology report chest (portable ap) study date of 1:35 pm , vicu 1:35 pm chest (portable ap) clip # reason: placement of dhft, post pyloric. medical condition: 70 year old woman with placement of dhft. please check placement. is it post pyloric. reason for this examination: placement of dhft, post pyloric. final report portable chest, comparison: . indication: feeding tube assessment. findings: a feeding tube is coiled within the stomach. with the exception of tube placement and apparent removal of right internal jugular sheath, there has not been a substantial change in the appearance of the chest since the recent prior radiograph. _ _ ________________________________________________________________ echo impression: the left atrium and right atrium are normal in cavity size. overall left ventricular systolic function is normal (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the ascending aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. brief hospital course: ms. presented to hospital in on w sharp diffuse abdominal pain associated with back pain. a ct scan obtained at showed an infected aaa endograft. she was transferred to for further management. she was placed on vancomycin, cipro, and flagyl. on she went to the operating room and underwent excision of the infected aortic endograft, aortic and iliac endarterectomies, and conversion to open retroperitoneal repair of abdominal aortic aneurysm with aorto-uni-iliac tube graft. gross purulence was found in the aneurysmal sac around the endograft. post-operatively she was taken to the cvicu for close monitoring and ventilatory support. the remainder of her hospital course will be in systems format. . neurological: immediately post-operatively she remained on a fentanyl drip for pain control and propofol/versed for sedation. this was changed to fentanyl prn post-extubation. her pain is currently managed on po dilaudid, a fentanyl patch, and gabapentin. she continued to have chronic lower abdominal pain so a cta was obtained on which showed no graft leak and no intra-abdominal abscess collection, but she did have a stable fluid collection around the aortic graft that did not appear to be infected. another ct was obtained on that showed a stable periaortic fluid collection. a psychiatric consultation was obtained at the patient's request due to concerns for depression. they concluded in their evaluation that she was not depressed and that she was coping appropriately. her ssri was discontinued for possible serotonin syndrome while on linezolid. she was started on low dose seroquel in place of her ambien. her tsh level was elevated at 30, but it was recommended that she stay on her current dose of levothyroxine 112mcg daily. . cardiovascular: in the immediate post-operative course she did require a neosynephrine drip to maintain adequate blood pressures but this was rapidly weaned off. she has remained hemodynamically stable throughout the remainder of her hospital course on her home antihypertensive regimen. . pulmonary: she remained intubated post-operatively and was successfully extubated on pod2. she was given aggressive pulmonary toilet by the nursing staff in the early post-operative period. she is now stable on room air. . gastrointestinal/nutrition: she remained npo during the immediate post-operative period. after extubation she was started on clear liquids and then advanced to a regular diet. her po intake remained poor for a number of days with poor calorie counts. a dobhoff tube was placed to initiate enteral feeds. she was against this at first but when it became clear to her that she was not eating enough she accepted this plan of care. she tolerated continuous tube feeds, so we began to cycle them overnight to stimulate her appetite. she was given a diet free of restrictions and began to increase her daily po intake. her family was also bringing her food from home and from her favorite restaurants. because of this and her adequate calorie counts were able to stop her tube feeds and remove the dobhoff tube. she is currently tolerating a regular diet without difficulty. . genitourinary: she required massive ivf resuscitation in the peri-operative period and was up about 30kg from her baseline weight. she was aggressively diureses with iv lasix and is now on a po regimen of 40mg . she is back to her baseline weight but does still complain of some dependent edema for which she continues the lasix. . hematological: she was transfused a total of 8units of prbcs and 2units of ffp. her hematocrit has remained stable in the 28-32 range and she has not required further transfusions. . endocrine: she does have diabetes and was on a diabetic diet, but to stimulate po intake this restriction was lifted. her blood sugars have been well controlled on sliding scale insulin. . infectious disease: she was placed on vanc/cipro/flagyl empirically on admission. her infected aaa endograft was removed and cultures sent from the operating room. aortic tissue, periaortic fluid swab, and a piece of the endograft itself all grew visa (vanc intermediate staph aureus). blood cultures drawn on also grew visa. repeat blood cultures since then have been no growth. once sensitivities returned she was started on rifampin po and linezolid iv. her linezolid was changed to po. she has not experienced any bone marrow suppression on the linezolid at this time. a urine culture from grew enterobacter and pseudomonas. she was started on cipro. a repeat urine culture was sent and this was no growth, so the cipro was discontinued. she is to be discharged on po rifampin and linezolid with clinic follow up. she is to have her cbc checked weekly to monitor for bone marrow suppresion. she reports a temperature spike to 102 on the evening of , but this was not recorded anywhere in her vital signs log. a cta was obtained on to evaluate for an intra-abdominal abscess and this showed a stable fluid collection around the aorta and no identifiable cause of her fever. she has since been afebrile. discharged to home with vna, home pt. folow up with dr. scheduled medications on admission: insulin riss, fentanyl patch q3 days, senna 1 capsule prn, lactulose 30ml prn, neurontin 30mg tid, coreg 12.5mg , cymbalta 30mg , protonix 40mg qd, norvasc 5mg , 325mg qd, bumex 1mg qd, synthroid 112mg qd discharge medications: 1. wheelchair device sig: one (1) miscellaneous once a day: manual w/c with 16" seat width and removable arm and leg rests for 4-6 weeks. disp:*1 1* refills:*1* 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): while decreased activity. 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 6. metoprolol tartrate 25 mg tablet sig: 2.5 tablets po tid (3 times a day). 7. quetiapine 25 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for prn insomnia. 8. acetaminophen 160 mg/5 ml solution sig: po q6h (every 6 hours) as needed for pain. 9. hydromorphone 2 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for pain. 10. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for yeast. 11. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 12. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 13. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for copd. 15. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 16. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 18. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 19. rifampin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours): lifelong medication . 20. insulin sliding scale insulin sc sliding scale q6h regular glucose insulin dose 0-70 mg/dl amp d50 71-120 mg/dl 0 units 121-160 mg/dl 2 units 161-200 mg/dl 4 units 201-240 mg/dl 6 units 241-280 mg/dl 8 units 281-320 mg/dl 10 units > 320 mg/dl notify m.d. 21. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days. discharge disposition: home with service facility: homehealth discharge diagnosis: septecemia pmh: hypertension diabetes gerd renal insufficiency hypothyroidism c-diff mrsa pneumonia dvt pvd discharge condition: stable discharge instructions: division of and endovascular surgery abdominal aortic aneurysm (aaa) surgery discharge instructions what to expect when you go home: 1. it is normal to feel weak and tired, this will last for weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have incisional and leg swelling: ?????? wear loose fitting pants/clothing (this will be less irritating to incision) ?????? elevate your legs above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? you should get up every day, get dressed and walk, gradually increasing your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (let the soapy water run over incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 101.5f for 24 hours ?????? bleeding from incision ?????? new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , md phone: date/time: 11:40 provider: , md phone: date/time: 11:30 provider: () lmob (nhb) phone: date/time: 8:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other revision of vascular procedure enteral infusion of concentrated nutritional substances arterial catheterization resection of vessel with replacement, aorta, abdominal transfusion of packed cells closed biopsy of skin and subcutaneous tissue transfusion of other serum endarterectomy, aorta endarterectomy, abdominal arteries injection or infusion of oxazolidinone class of antibiotics procedure on two vessels diagnoses: other chronic pain esophageal reflux urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified other acute pain infection and inflammatory reaction due to other vascular device, implant, and graft streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pseudomonas infection in conditions classified elsewhere and of unspecified site above knee amputation status methicillin resistant staphylococcus aureus septicemia edema 

Answer: The patient is high likely exposed to