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: nafcillin attending: chief complaint: epidural abscess and vertebral osteomyelitis and discitis major surgical or invasive procedure: : s/p l thoracotomy, vertebrectomy t10, partial vertebrectomy t11, instrumented fusion t9-t11. chest tube to 20 cm h2o continuous suction. : rigid bronchoscopy x2. removed chest tube. : posterior spinal fusion t5-l2, est blood loss 1050 ml transfused 3 u prbc, 2 u ffp. history of present illness: mr. is a 45yo man with esrd on hd, dm, h/o "staph bacteremia" in for which he was treated at an osh, h/o t11-12 discitis in who presents as a transfer from hospital with report of possible epidural abcess. mri was read at osh (by attg) as t11-12 discitis vs. osteomyelitis with a possible epidural abcess and small cord compression. he was transferred here for neurosurgical eval and was seen by ortho spine team in the er. the ortho and radiology residents examined the mri and are not convinced the pt has epidural abcess, although are unsure. the pt was admitted to medicine for perioperative management. ros: past medical history: esrd on hd dm t11-12 discitis in ?staph bacteremia in social history: works as police dispatcher, lives in with a roommate. . family history: noncontributory physical exam: vitals t 99.6 bp 154/88 ar 130 rr 21 o2 sat 93% on nrb, 5l nc gen: patient appears acutely ill heent: mmm heart: sinus tachycardia, +systolic murmur lungs: decreased bss from on l from posterior base to apex, scattered crackles on r side abdomen: soft, nt/nd, +ns extremities: no edema, 2+ dp/pt pulses bilaterally pertinent results: glucose-103 urea n-18 creat-4.5* sodium-144 potassium-4.3 chloride-100 total co2-32 wbc-6.5 rbc-4.19* hgb-12.3* hct-37.8* mcv-90 mch-29.3 mchc-32.5 rdw-16.5* plt count-319 - neuts-68.3 lymphs-22.1 monos-7.0 eos-1.5 basos-1.0 lactate 1.0. . ct - anterior wedge deformities of t10 and t11 with moderate kyphosis. there is fragmentation and destruction of the inferior t10 and superior t12 endplates concerning for osteomyelitis/discitis. surrounding soft tissue density may represent phelgmon. no paraspinal fluid collections identified. ct does not provide intrathecal detail, and mri is recommeded for further evaluation of the spinal cord. . mr at osh: t11-12 discitis vs osteomyelitis with possible epidural abcess and some possible cord compression . 1)cxray (): improved aeration of the left lower lobe. . 2)cxray (): new complete opacification of the left hemithorax with associated minimal right to left shift of the trachea likely reflects underlying effusion and atelectasis, cannot exclude pneumonia. brief hospital course: mr. is a 45yo male transferred to from where he presented to the er with c/o chronic, severe lower back pain & weakness in his le bilaterally. . back pain/osteomyelitis on arrival to er was given dilaudid 1 mg iv with no relief & was subsequently given morphine 7 mg iv. stat mri of the spine was ordered which showed "progression of osteomyelitis versus discitis at the t10-t11 region with further collapse. possible pus in the disc space. there is compression of the anterior cord which is significantly increased from ." . per neurosurgery at (dr. pt would need surgery with anterior approach & thus transfer to tertiary care facility. patient was discussed with dr. at and transferred in stable condition. . mr. was seen in er by ortho spine team; ortho spine and radiology residents examined mri from osh and were not convinced of presence of epidural abscess, although unsure. patient was thus admitted to medicine service for perioperative management. . in our ed he received dilaudid for pain, a ct of his t-spine and additional blood cultures were drawn. ct of t-spine showed "anterior wedge deformities of t10 & t11 with moderate kyphosis. there is fragmentation and destruction of inferior t10 and superior t12 endplates concerning for osteomyelitis/discitis. surrounding soft tissue density may represent phlegmon. no paraspinal fluid collections identified." further orthopedics consult recommended non-emergent surgical decompression and debridement due to failure of medical management and progression of symptoms. . renal was made aware of pt with esrd who receives scheduled hd on mwf & recommended to hold colchicine in hd patient. id also consulted on day of admission () and advised to hold abx and perform tte prior to surgery (performed which showed no vegitations). patient was made npo overnight for surgery the following morning and coags/type & screen were sent. surgery not performed , was examined by dr. of neurosurgery for 2nd opinion who also recommended anterior/posterior decompression with fusion. . patient went to or for l thoracotomy with t10 vertebrectomy and t11 partial vertebrectomy with fusion/anterior cage placement t9-t11. patient remained sedated on propafol & intubated with l pleural chest tube post-operatively and was extubated , mom placed on cpap and weaned to o2 by nc. for pain control pt received dilaudid pca with scheduled dilaudid 2 mg q 2 hours. . started on iv nafcillin for history of recurrent mssa bacteremia; on pod#3 operative tissue cultures grew mssa, confirming this diagnosis. patient also noted to be tachycardic post-operatively, most likely due to uncontrolled pain, and required increase in lopressor dose. . patient remained sedated on propafol and intubated and was sent back to or on for completion of posterior spinal fusion. . post-operatively patient received care in micu and antibiotics were changed back to iv nafcillin. per id recs, would need at least a week course of cefazolin due to his h/o recurrent mssa bacteremia. he will then likely require lifetime suppressive therapy. id follow-up needs are described in page 1/discharge instructions. . as he recovered from the problems described below, he continued to have flares of intense back pain which we attempted to control. . he was successfully moved out of bed with a torso brace on, on . physical therapy continuing to work with mr to facilitate his recovery. current neuro exam: hard to assess weakness in this context, possible l weaker than r; loss of sensation of first three toes of l toe. . respiratory failure during hd pod#3 () patient noted to have o2 sat of 80% and with nrb recovered sats to 99%. cxr showed complete opacification of l lung and patient was transferred to micu team for respiratory distress. at that time differential dx was mucous plugging vs. l chest tube malfunction and per surgery patient was noted to have ++ secretions. . in micu patient was started on face mask, empiric ceftriaxone and azithromycin for cap, atrovent & albuterol neb treatments. sputum samples were sent for culture. patient was bronched @ 17:30 by the micu service. thick, purulent, mucoid secretions were visualized in the l mainstem and l lingula. bal was perfomed in the lingula after which he developed copious fresh blood requiring intubation. post bronch cxr (17:45) actually revealed an aerated l lung with significant improvement. . he was bronched again at 19:30 which revealed thick secretions in the l mainstem and the end of the ett. post-bronch cxr (19:45) demonstrated l ptx and again l white-out.later that day patient was intubated & bronchoscopy was performed which showed thick, purulent secretions in l mainstem and l lingula. bal was peformed in l lingula after which developed copious fresh blood. wedge was kept in, bleeding slowed and fibrinous bloody material was suctioned from ett. . on cxrs l chest tube appeared to be kinked at chest wall, was pulled and restitched in an attempt to reposition the tube and decrease the kink. chest tube was d/c'd on . . started on iv vancomycin and zosyn to cover s.aureus and gram negative/anaerobes. . thrombocytopenia hit +. platelets decreased to 12 . the differential diagnosis was dic vs hit vs drug effect (?nafcillin). did have elevated fibrinogen and d-dimer, but this was muddied by the fact that he still had active osteomyelitis and these are acute phase reactants. fibrinogen was increased and thus less concerning for dic. he was transfused one unit of platelets, and heparin and nafcillin were discontinued. . he was switched to cefazolin for his osteomyelitis. he received argatroban on 8.25 with a plan to bridge to coumadin. however he got a very high inr with this (up to 9.4) and required 2 units ffp and 10 mg vitamin k, with inr going down to 1.5 on . argatroban was discontinued. low dose warfarin was briefly started. a pf4 assay was weakly positive for hit antibodies (optical density just over threshold for judging positive) and a confirmatory serotonin release assay was negative, strongly suggesting that hit was not responsible for the platelet drop. therefore the likely culprit was judged to be nafcillin based on prior case reports of this phenomenon and based on timing. cefazolin was kept as the antibiotic as above; subcutaneous heparin was restarted for dvt prophylaxis. . pain continues to be uncontrolled. pain service on board. initially on dilaudid pca for control but started ketamine & fentanyl drips per pain mgmt recommendations. drips eventually weaned & discontinued on . fentanyl patch continued and dilaudid pca restarted on . prior to transfer to floor patient started on oral regimen of diluadid 6 mg po q 3 hrs. fentanyl patch increased, pca weaned off, and patient now on oral regimens. of note, pt has much increased pain with movement/ transport/ physical therapy; should likely be pre-medicated for pt, may need to increase doses of po prn meds as pt becomes more frequent. . elevated bilirubin did have elevated bilirubin during some of micu stay. total bilirubin trending down since : 8.3--> 5.3-->4.5; direct bilirubin 7.2 on . by it was 1.3 after a long downward trend. ruq us showed sludge in gallbladder with no evidence of cholelithiasis/cholecystitis. no clear diagnosis for elevation but now fine. . type 2 dm was on standing nph and humalog sliding scale as outpatient with hypoglycemia. bs were reasonably well-controlled though some adjustments in dose were needed. he was restarted on nph on the floor and has been doing well with this, again with a few adjustments to optimize his regimen. clinic consult service saw him and advised re his regimen. . renal failure continued dialysis here in the hospital. received lanthanum as a phosphate binder. renal dialysis team followed along with care. per renal fellow, fine to transition from lanthanum to renagel (selvalamer) 1600 mg po tid. (discharge meds reflect this recommendation; change was made on discharge, not before.) . htn transitioned back to home bp meds when diet was advanced. . gout continued with home allopurinol . fen diabetic po diet. bowel regimen. . prophylaxis +compression boots, subcutaneous heparin, ppi . access rij in place since admission, discontinued on upon placement of right picc line . code full . medications on admission: ?? 1. lidoderm patch q 12 hrs 2. fentenyl patch 75mcg q3 days 3. celebrex 200mg daily 4. atenolol 25mg daily 5. ambien 5mg qhs prn 6. zetia 10mg daily 7. nph 55 units qam/70qunits q pm 8. nephrocaps 1 daily 9. nystatin powder 10. humalog sliding scale 11. colchicine 0.6mg daily 12. allopurinol 100mg daily 13. asa 81mg daily 14. catapres q monday discharge medications: 1. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. miconazole nitrate 2 % powder sig: one (1) appl topical hs (at bedtime). 5. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 6. sevelamer 800 mg tablet sig: two (2) tablet po with meals. 7. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. 8. clonidine 0.2 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qsat (every saturday). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. diazepam 5 mg tablet sig: one (1) tablet po q6h (every 6 hours). 11. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. hydromorphone 4 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 14. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). 15. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 18. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 19. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 20. prochlorperazine 10 mg tablet sig: 0.5-1 tablet po q6h (every 6 hours) as needed for nausea. 21. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch transdermal q72h (every 72 hours): total fentanyl dose should total 175 mcg/hr, in any configuration of doses for patch(es). 22. fentanyl 75 mcg/hr patch 72 hr sig: one (1) patch transdermal every seventy-two (72) hours. 23. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 24. cefazolin 2 gm iv post hd on monday and wednesday 25. cefazolin 3 gm iv post hd on friday 26. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 27. lorazepam 0.5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 28. insulin lispro 100 unit/ml solution sig: one (1) injection subcutaneous with meals, and at bedtime, per sliding scale: sliding scale. dose by glucose level. meal scale, breakfast, lunch, dinner: glu 76-150: 0 units. glu 151-200: 2 units. glu 201-250: 5 units. glu 251-300: 8 units. glu 301-350: 11 units. scale: glu 76-150: 0 units. glu 151-200: 0 units. glu 201-250: 2 units. glu 251-300: 4 units. glu 301-350: 6 units. glu 351-400: juice and recheck. discharge disposition: extended care facility: rehab unit at - discharge diagnosis: primary: osteomyelitis/diskitis mssa septicemia . secondary: diabetes mellitus type 2 end-stage renal failure on hemodialysis discharge condition: good discharge instructions: as much as your pain will permit, work with physical therapists to try to use your muscles and progress towards walking as soon as possible. followup instructions: please obtain weekly cbc and chem 7, fax results to infectious disease department (attn: dr : . nephrology/hemodialysis: as arranged by dialysis unit . infectious disease clinic: ,md mph: date/time: 11:00 . orthopedic/spine clinic: dr. phone: date/time: 10:00 ortho xray (scc 2) phone: date/time: 9:40 . procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis other bronchoscopy other lavage of bronchus and trachea dorsal and dorsolumbar fusion of the anterior column, anterior technique excision of intervertebral disc transfusion of packed cells dorsal and dorsolumbar fusion of the posterior column, posterior technique transfusion of other serum transfusion of platelets excision of bone for graft, scapula, clavicle, and thorax [ribs and sternum] insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae application or administration of an adhesion barrier substance fusion or refusion of 9 or more vertebrae diagnoses: pneumonia, organism unspecified end stage renal disease acute posthemorrhagic anemia gout, unspecified hematoma complicating a procedure pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hemorrhage complicating a procedure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intraspinal abscess acute osteomyelitis, other specified sites kyphosis (acquired) (postural) diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled intervertebral disc disorder with myelopathy, thoracic region pathologic fracture of vertebrae foreign body in larynx 

Answer: The patient is high likely exposed to