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: sulfa (sulfonamides) attending: chief complaint: sepsis major surgical or invasive procedure: 1) bedside incision and drainage, right hand 2) operative incision and drainage, right hand 3) arthroscopic wash out, bilateral shoulders 4) percutaneous pigtail drainage of mid thoracic paravertebral abscess under radiographic guidance 5) left picc, placed , repositioned history of present illness: 54 f with crohn's disease on prednisode and remicade, receiving tpn through a picc, admitted to an outside hospital on with two weeks of right hand swelling, fevers, and chills. at the osh emergency department, she was ill-appearing, hypotensive, and afebrile, with a leukocytosis to 22 with 15% bandemia and 70% polys; her creatinine was 1.7. she was admitted to the micu at the osh where she was given stress dose steroids, empiric vancomycin and levofloxacin, 4l ivf, and blood cultures drawn. an ultrasound guided drainage of the right hand was performed, expressing a small amount of pus that was sent for gram stain and culture; gram stain showed 2+ gram positive cocci. four of four blood cultures grew gram positive cocci, as well. she subsequently developed respiratory distress overnight with an arterial blood gas of 7.2/14.5/95 and was intubated. chest x-ray at the osh was consistent with ards vs volume overload. an mri of the right hand showed no definite fluid collection. . an attempt at a right subclavian central catheter prior to transport failed, and a right femoral line was placed instead. she received versed and vecuronium and was transported to by . past medical history: crohn's, longstanding on remicade, 5mg prednisone short bowel syndrome tpn through picc rheumatoid arthritis social history: lives at home with husband etoh, ivda. family history: non-contributory physical exam: 100.9 130 104/53 31 100% on ac500x22 w/peep 8 and fio2 1 intubated, sedated mmd, perrl rll crackles, dtp tachy, i/vi hsm @ apex; site of multiple r subclav attempts evident but clean soft, nt, nd, +bs wwp x 4; r hand swollen; r fem line c/d/i; multiple stick sites evident not responding to commands, pain pertinent results: admission laboratories: 02:13pm blood wbc-26.7* rbc-3.78* hgb-11.0* hct-32.8* mcv-87 mch-29.1 mchc-33.5 rdw-15.2 plt ct-235 02:13pm blood neuts-90.3* bands-0 lymphs-7.5* monos-1.7* eos-0.1 baso-0.4 . 02:13pm blood glucose-151* urean-37* creat-0.9 na-143 k-3.6 cl-116* hco3-15* angap-16 02:13pm blood albumin-2.2* calcium-7.6* phos-6.5* mg-1.6 . 02:13pm blood pt-14.0* ptt-42.1* inr(pt)-1.2* 02:13pm blood fibrino-576* d-dimer-8768* . 02:13pm blood alt-25 ast-55* ld(ldh)-257* ck(cpk)-175* alkphos-276* totbili-3.7* . 04:43pm blood type-art temp-38.3 po2-75* pco2-42 ph-7.06* calhco3-13* base xs--18 intubat-intubated . discharge laboratories: 05:00am blood wbc-8.5 rbc-3.26* hgb-9.0* hct-27.8* mcv-85 mch-27.8 mchc-32.5 rdw-17.9* plt ct-521* . 05:17am blood glucose-105 urean-26* creat-0.7 na-136 k-4.2 cl-104 hco3-23 angap-13 05:17am blood calcium-8.7 phos-3.0 mg-1.9 . other relevant laboratories: 03:53am blood esr-135* 03:02am blood crp-149.6* . 05:44am blood cortsol-20.4* . relevant studies: chest - portable ap (): poorly defined nodular opacities in right upper and left mid lung zones, concerning for septic emboli or fungal infection. . ct chest w/contrast (): the heart and great vessels are unremarkable. a single right axillary lymph node measures 1 cm. there are no other pathologically enlarged mediastinal lymph nodes. the airways are patent bilaterally. there is a small right pleural effusion with associated atelectatis. lung windows revea severe emphysematous changes. there are multiple bilateral, scattered varying- sized rounded and irregular non-cavitating focal pulmonary opacities, predominantly with a peripheral location. in the left posterior paraspinal musculature just deep to the trapezius muscle extending inferiorly from the c1 level , there is a rim enhancing multiloculated fluid collection concerning for abscess. in the region of the lower thoracic spine there is an apparent encapsulated prevertebral fluid collection adjacent to the right pleural effusion, and with low but slightly higher density than the free pleual effusion. no gas is present within this effusion but the vertebral bodies at this level (probable t8.9 and 10) demonstrate a mixed sclerotic/ lytic pattern and findings are concerning for osteomyelitis. . mr t-spine w &w/o contrast (): there are signs of extensive osseous abnormality of the mid thoracic spine with a prevertebral collection associated with bone and interspace abnormality. this is most suspicious for infection and abscess formation. there is also an adjacent pleural effusion, and extension of an infectious process into this space should be considered. an area suspicious for large abscess collection is also identified in the subcutaneous musculature of the posterior back extending from roughly c7, 8 cm inferiorly into the thoracic region, to about t5. abnormality at the c1-2 junction is also identified and though this could represent degenerative change, but infection cannot be excluded in this location. . tee (): no spontaneous echo contrast is seen in the body of the left atrium or right atrium. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function appears preserved (lvef>55%), however transgastic views were not obtained. right ventricular systolic function also appears preserved. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. no mitral valve abscess is seen. trivial mitral regurgitation is seen. there is no abscess of the tricuspid valve. no vegetation/mass is seen on the pulmonic valve. . ct of the chest with iv contrast (): pulmonary arteries appear well opacified and there is no evidence of acute pulmonary embolism. heart and great vessels appear unremarkable. again seen are several mediastinal lymph nodes, however, none appear to meet ct criteria for pathological enlargement. there is no evidence of pathologically enlarged hilar or axillary lymphadenopathy. there has been interval improvement of previously seen small right-sided pleural effusion. again seen are diffuse emphysematous bullous changes bilaterally. three poorly-defined peripheral opacities are present in the right lung. the opacity seen on series 3, image 39, does not appear significantly changed from prior study. new linear/nodular opacities seen on series 2, image 34, possibly represents atelectasis. also seen is a smaller irregular peripheral opacity, best seen on series 3, image 55. peripheral opacity in the left lung (series 3, image 49) appears improved compared to prior study. again seen is a paraspinal abscess collection anterior to the mid thoracic region. small amount of fluid is again seen, decreased compared to . compared to , the fluid collection is likely not significantly changed to slightly larger in size. soft tissue inflammation is also seen in this area. again seen is destruction of the t7 through t9 vertebral bodies. . ct of the abdomen with iv contrast (): the liver, pancreas, spleen, adrenal glands, and kidneys appear unchanged. the bile duct measures 9 mm, not changed from prior study. there is no evidence of free fluid or free air within the abdomen. scattered mesenteric lymph nodes again seen, however, none appear to meet ct criteria for pathologic enlargement. . ct of the pelvis with iv contrast (): the rectum and sigmoid appear unremarkable. small amount of air is noted within the bladder, correlate with recent catheterization. small area of enhancement again noted within the left psoas muscle, previously described as abscess, not significantly changed from prior study. . bone windows (): again seen is destruction of the t7 through t9 vertebral bodies. degenerative changes also again noted within the spine, most notably at the l5 level. . microbiology: staph aureus coag + | erythromycin---------- 1 i gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s penicillin------------ =>0.5 r brief hospital course: 1) sepsis/disseminated infection: patient was transferred from osh for sepsis thought secondary to a hand infection. an initial incision and drainage of the right hand abscess had been performed at the osh. here, she was started on vancomycin with gentamycin at synergistic dosing for gram positive cocci on outside hospital cultures. she was aggressively resuscitated with iv fluids, with levophed for additional pressure support. she received a course of xigris and stress dose steroids. when cultures showed mssa on hd #2, vancomycin was changed to nafcillin. gentamycin was stopped after 5 days of synergistic dosing. she was weaned off of pressor support by hd #4 and remained hemodynamically stable thereafter, although she remained intubated on mechanical ventilation to facilitate operative debridement of her right hand osteomyelitis. . although she subsequently remained hemodynamically stable, she continued to be febrile. there was concern for line infection. her chronic picc for home tpn was removed at the outside hospital. left and right internal jugular central catheters placed since admission were removed, as well as her arterial line. a new left subclavian catheter was placed. however, she continued to remain febrile. . a transesophageal echocardiogram was performed, which showed no evidence of endocarditis. a chest x-ray showed pulmonary nodules, prompting a follow up ct of the chest. this showed nodular opacities consistent with septic emboli. in addition, it showed two fluid collections, one involving the vertebral bodies of t8-t10, and another in the left paraspinal muscles extending inferiorly from c7. a ct of the abdomen and pelvis showed a left iliopsoas abscess. . the orthopaedic spine team was consulted, and an mri of the spine was obtained for further delineation of these lesions. the mri confirmed osteomyelitis of the t9 vertebra, and showed a fluid collection abutting the spine in addition to a fluid collection subcutaneously on the back. the orthopaedic spine service recommended a conservative approach with ct guided drainage of the paraspinal fluid collection. the infectious diseases team agreed with a strategy of attempting to treat each locus of infection discretely and attempt drainage. however at this point, the infection appeared fairly disseminated and there was some concern that the infection would be difficult to eradicate. the pulmonary nodules were felt to not be accessible by bronchoscopy, and not large enough for percutaneous drainage. the left iliopsoas abscess was likewise felt not to be amenable to drainage. these concerns were shared with the patient and the family. the patient underwent successful ct guided drainage of the superficial abscess on the back, in addition to the paraspinal fluid collection (with a pigtail catheter left in place for drainage). . she was called out to the floor where she continued to be febrile. plans were made for ct guided drainage of the parascapular abscess. however, the scan showed no drainable fluid in the parascapular region. the t8-t10 paraspinal fluid collection was persistent, but slightly improved. incidentally, however, it showed bilateral shoulder effusion. orthopaedics performed a joint aspirate, which returned grossly cloudy fluid, with 41k wbcs and a negative gram stain. she was taken to the operating room for bilateral shoulder washouts, which she tolerated well. . she subsequently defervesced, and was afebrile x 1 week prior to discharge. she was discharged with plans for an indefinite course of nafcillin. . 2. pain control: she was initially placed on a morphine pca for pain control, but had difficulty operating the pca. she was changed to a fentanyl patch with iv dilaudid boluses for breakthrough. iv dilaudid was transitioned to po dilaudid prior to discharge. on discharge, her pain was well controlled on 25 mcg/hr fentanyl patch with 8mg po dilaudid q2h for breakthrough pain. . 3. respiratory failure: the patient had developed respiratory failure at the osh and arrived on mechanical ventilation. this was thought secondary to non-cardiogenic pulmonary edema in the setting of sepsis. her ventilator settings were weaned, and she was clinically ready for extubation several days after admission. however, she remained intubated for an additional days because of planned hand surgery by plastic surgery. she was extubated successfully on the following day, although her respiratory status remained tenuous. she was reintubated on for a tee and again successfully extubated on after the tee. her respiratory status was stable through the remainder of her course on the floor. . 4. crohns: she was given a short course of stress dose steroids on arrival, as described above, and subsequently put on 4mg iv solu-medrol qd. she was transitioned back to her home regimen of prednisone 5 mg po qd prior to discharge. she was maintained on tpn throughout her hospitalization for short gut syndrome. it was initially run by continuous infusion, but was transitioned to a cycled regimen over 12 hours prior to discharge. her crohns was otherwise stable, without any complaints of abdominal pain. 5. cardiac: she had a mild troponin t leak ~ 0.7, with a peak ck-mb of 95. this was felt to be demand related in the setting of sepsis. an initial tte showed a depressed ef. however, this recovered on subsequent tees. . 6. anemia: patient had a stable anemia with iron studies consistent with chronic inflammation. . 7. tachycardia: patient was noted to be persistently tachycardic during hospitalization. this was confirmed to be sinus by ecg, and thought most likely multifactorial from anxiety, pain, and her hypermetabolic state from infection. in addition to treatment of her underlying infection and pain control described above, she was given anxiolytics as needed. ct was negative for pe. . 8. acidosis/hyperkalemia: the patient was noted to have a metabolic acidosis on admission. this corrected spontaneously over the subsequent several days. however, as the acidosis resolved, she developed a significant hypokalemia, with potassium levels down to 2.4. there were no ecg changes. potassium was repleted aggressively over the following several days, with subsequent resolution. . prophylaxis: she received heparin in her tpn for dvt prophylaxis. . code status was confirmed to be full. medications on admission: remicaide prednisone 5 mg discharge medications: 1. nafcillin in d2.4w 2 g/100 ml piggyback sig: two (2) gram intravenous q4h (every 4 hours). disp:*2 week supply* refills:*2* 2. fentanyl 25 mcg/hr patch 72hr sig: one (1) patch transdermal q72h (every 72 hours). disp:*10 patch(s)* refills:*0* 3. hydromorphone 8 mg tablet sig: one (1) tablet po q2-4h as needed. disp:*100 tablet(s)* refills:*0* 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 6. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical (2 times a day). disp:*1 bottle* refills:*2* discharge disposition: home with service facility: discharge diagnosis: mssa sepsis septic pulmonary emboli left ileopsoas abscess t9 paraspinal abscess with t7-9 vertebral osteomyelitis - s/p percutaneous pigtail drain parascapular abscess right hand abscess - s/p open irrigation and debridement crohns disease discharge condition: stable afebrile discharge instructions: 1) continue your medications as prescribed - you were started on an antibiotic called naficillin for multiple infections in your body. you need to continue this until you have back surgery, and likely for 6 weeks afterwards. 2) follow up as directed below. 3) call if any of your wounds looks worse, has worsened redness or pain, discharge, if you have chest pain, difficulty breathing, nausea, fevers, chills, or any other concerns. followup instructions: follow up with dr (orthopaedics) for your shoulders on at 10:00am - call if you have questions or need to reschedule. follow up with dr (orthopaedic spine) at 11:00am - his coordinator will try to get you an earlier appointment. if possible, they will contact you at home. - call if you have questions or need to reschedule. follow up with dr (id) on at 9:00am. - call if you have questions or need to reschedule. follow up with dr in plastic surgery hand clinic on at 9am. - call if you have questions or need to reschedule. you asked to transfer your primary care here to the , and were scheduled for an appointment with dr in the clinic atrium suite on at 1:30pm - you need to call your insurance company to change your listed pcp. after you change your pcp, the clinic at to request referrals for the specialists listed above. you will need these referrals before you see any of the specialists. md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart diagnostic ultrasound of heart other incision with drainage of skin and subcutaneous tissue arthrocentesis transfusion of packed cells aspiration of other soft tissue infusion of drotrecogin alfa (activated) infusion of vasopressor agent attachment of pedicle or flap graft to hand excision of other lesion of soft tissue of hand other arthrotomy, shoulder diagnoses: anemia of other chronic disease cellulitis and abscess of trunk long-term (current) use of steroids acute kidney failure, unspecified severe sepsis methicillin susceptible staphylococcus aureus septicemia other specified forms of chronic ischemic heart disease regional enteritis of unspecified site septic shock cellulitis and abscess of upper arm and forearm acute osteomyelitis, other specified sites other and unspecified postsurgical nonabsorption mechanical complication of other vascular device, implant, and graft fistula of intestine, excluding rectum and anus cellulitis and abscess of hand, except fingers and thumb pyogenic arthritis, shoulder region acute osteomyelitis, hand psoas muscle abscess unspecified inflammatory spondylopathy attention to ileostomy 

Answer: The patient is high likely exposed to