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: penicillins attending: chief complaint: abdominal pain major surgical or invasive procedure: femoral line placement ir guided picc line placement history of present illness: 55 y.o. female with dm1, htn, and hepatitis c who presents with a chief complaint of abdominal pain. patient is somewhat tengential and thus history is limited, but as can best be understood, she noticed the gradual onset of constipation approximately 2 weeks ago, a symptom that in the past has suggested the onset of a gastroparesis flare. over the course of the following 2 weeks, she developed abdominal pain, reports brbpr and "dark stool", though not clearly melena, as well as intermittent fevers, elevated fs (>600) as high as 104.4 the night prior to admission. on the night prior to admission, she developed nausea/ and describes a coffee-ground emesis. she denies any contacts, recent travel, or consumption of poorly-cooked food. she says that her current symptoms are consistent with her prior episodes of gastroparesis. . upon presentation to the ed, vitals were notable for tachycardia, but otherwise normal. labs were notable for a bg of 754, severe metabolic acidosis with a gap of 34, elevated lactate, 150 ketones in the urine and a bicarb of 9. she also had a leukocytosis of 21 (without bands) and acute renal with a creatinine of 1.9, up from 0.7. a femoral line was placed and she was given several liters of ns, later switched to 1/2 ns since a corrected sodium actually revealed hypernatremia. an insulin drip was also started, initially at 5, then increased to 10. additionally, ng lavage showed some small clots without coffee grounds or active bleeding. rectal exam revealed brown, guaiac positive stool. ua was negative as was a cxr for signs of infection. ekg showed sinus tachycardia without ischemic changes and troponin was negative x 1. given the elevated lactate, guaiac positive stool and abdominal pain, a ct abdomen was obtained (without contrast given renal failure) and though limited, did not comment on any acute intraabdominal process. kub likewise did not show an obstructive pattern, though the colon was full of stool. ciprofloxacin and flagyl were started empirically to cover a bowel process. patient was thus admitted to the icu for further management of dka. . upon arrival to the icu, patient was resting in bed, appearing comfortable, though complaining of "20/10" abdominal pain. past medical history: 1. dm type 1: years w/ dm: 5 age of diag: 48 year diag: several episodes of dka (last one in ), managed on 36u lantus plus hiss 2. diabetic polyneuropathy 3. hypertension 4. grave's disease s/p rai 5. reactive airway disease 6. seronegative arthritis, followed in rheumatology 7. hepatitis c, genotype 1a, biopsy with grade 1 inflammation, never been on antiviral therapy, acquired via blood transfusion during surgery in 8. gerd 9. migraines 10.bilateral knee arthroscopy in 11.s/p tah and pelvic floor surgery with bladder lift 12.depression 13. bone spurs in feet social history: patient lives in a multi apartment building in the same apartment with a daughter, grandaughter, and grandson. she has a son, daughter and another brother who live on another floor. she is a never smoker and does not use alcohol or drugs. she has not worked for many years. family history: her mother died of colon cancer. there are multiple family members with dm. physical exam: vitals: t: 97.8, bp: 138/78, p: 110 r: 20 o2: 100% ra general: awake, alert, somewhat tangential, but reorientable. ngt in place : nc/at; perrla, eomi; op clear, nonerythematous, dry mucous membranes neck: supple, jvp not elevated, no lad lungs: ctab cv: s1, s2 nl, no m/r/g appreciated. rapid rate abdomen: soft, tender to palpation diffusely without rebounding or guarding, no organomegaly, + bs ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 08:35am blood wbc-21.4*# rbc-4.43 hgb-12.0 hct-38.0 mcv-86 mch-27.1 mchc-31.7 rdw-14.3 plt ct-481*# 03:50pm blood wbc-4.8 rbc-3.58* hgb-9.9* hct-29.9* mcv-84 mch-27.7 mchc-33.1 rdw-15.8* plt ct-347 08:35am blood pt-13.8* ptt-29.3 inr(pt)-1.2* 08:35am blood glucose-754* urean-33* creat-1.9*# na-133 k-4.2 cl-91* hco3-9* angap-37* 05:33am blood glucose-159* urean-8 creat-0.8 na-138 k-4.3 cl-104 hco3-30 angap-8 08:35am blood alt-16 ast-19 ck(cpk)-45 alkphos-147* totbili-0.5 08:35am blood ctropnt-<0.01 05:06pm blood ck-mb-notdone ctropnt-<0.01 05:59am blood ck-mb-4 ctropnt-<0.01 05:06pm blood calcium-8.4 phos-2.2* mg-1.9 05:06pm blood tsh-0.049* 05:59am blood free t4-1.4 05:28am blood vanco-15.0 09:08am blood glucose-greatear t lactate-4.6* na-136 k-4.3 cl-98* 11:14am blood lactate-2.9* 06:05pm blood lactate-1.2 09:08am blood freeca-1.22 blood cx's: 5/25 9:30 am blood culture right groin line red. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 1 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ <=1 s surveillence blood cx's: - no growth catheter tip cx: negative for growth brief hospital course: # diabetic ketoacidosis: patient with anion gap of 34 on initial presentation to the ed with glucose >500, most recently 24. started on insulin gtt in ed, lactate elevated at 4.6 which was downtrending/normal on discharge. cxr negative for infiltrate and ua without pyuria. ekg without ischemic changes and cardiac enzymes negative x 1. most likely etiology to dka likely coagulase negative staph bacteremia from femoral line versus gastroparesis leading to and constipation. patient was weaned off of insulin gtt and back to home dosing of insulin. consulted and recommended switching lantus to 28 . patient tolerating full diet at discharge, and dobhoff was removed. #coagulase negative staph bacteremia: noted to have 2/2 bottles of gpcs in clusters and pairs growing from ed blood cultures. no obvious source of infection (no overt cellulitis, open wounds, or recent dental cleanings). blood cultures drawn from femoral line. no murmurs on exam or stigmata concerning for endocarditis. patient has a history of cns bacteremia (, , ), and was previously treated in the pat with 14 day course. tte showed no evidence of vegetations. femoral line was pulled with no growth from tip culture and surveillance cultures were negative for 48 hours. given that the patient had dka, leukocytosis, and low grade fevers, the cns bacteremia was treated with a 14 day course of vancomycin, and a picc line was placed. # acute renal failure: likely secondary to pre-renal azotemina in setting of poor po intake and dka. improved with ivfs and correction of dka. # question of gib: patient with history of hepatitis c, though no varices on serial egds (last in ). also with history of grade 1 hemorrhoids on colonoscopy in , otherwise no lesions. report of rectal bleeding could be exacerbation of hemorrhoids in the setting of constipation. ng lavage is reassuring for ugib being unlikely. patient reports eating beef stew and then , so 'coffee ground emesis' may have been related to this. however, still discharged patient on a ppi with instructions to have an outpatient upper endoscopy on discharge given her history of hepatitis c and potential for upper gi bleed. # gastroparesis/constipation: current flare is similar to prior episodes per patient and constipation is likely a consequence of known gastroparesis. no evidence of obstruction on imaging. continued aggressive bowel regimen with lactulose followed by colace/senna/dulcolax/miralax. tfts consistent with euthyroid syndrome. pain was controlled with prn morphine. patient was kept npo and advanced diet as tolerated. tolerating full diet and dobhoff removed on discharge. # hypertension: held anti-hypertensives while hypovolemic/in dka and restarted on the floor. # grave's disease: tsh suppressed, but tfts consistent with euthyroid. continued methimazole. # reactive airway disease: continued home inhalers. # seronegative arthritis: restarted patient on home regimen of sulfasalazine. # hepatitis c: not currently on anti-viral therapy. lfts stable # gerd: continued proton pump inhibitor. # depression: continued amitryptiline # hyperlipidemia: continued statin medications on admission: amitriptyline 25 mg po qhs diazepam 5 mg po bid flovent gabapentin 600 mg po tid lantus 28 units with sliding scale (though as high as 35 units recently) losartan 50 mg po qd methimazole 10 mg po tid metoclopramide 10 mg tid montelukast 10 mg po qd naproxen 500 mg po bid pantoprazole 40 mg po qd percocet 5/325mg po q6h: prn serevent simvastatin 10 mg po qd sulfasalazine 1000 mg po bid zomig 2.5 mg po qd docusate 100 mg po qd discharge medications: 1. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 2. methimazole 10 mg tablet sig: one (1) tablet po tid (3 times a day). 3. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 4. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 5. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 9 days. disp:*18 gram* refills:*0* 6. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. diazepam 5 mg tablet sig: one (1) tablet po bid (2 times a day). 8. naproxen 500 mg tablet sig: one (1) tablet po q12h (every 12 hours). 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 10. sulfasalazine 500 mg tablet sig: two (2) tablet po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day). 13. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). 14. polyethylene glycol 3350 17 gram (100 %) powder in packet sig: one (1) po daily (daily): hold for loose stools. disp:*10 packets* refills:*2* 15. zomig 2.5 mg tablet sig: one (1) tablet po once a day. 16. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 17. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic daily (daily). 18. losartan 50 mg tablet sig: one (1) tablet po once a day. 19. insulin glargine 100 unit/ml cartridge sig: one (1) subcutaneous twice a day: 28 units qam 28 units qpm . disp:*60 syringes* refills:*2* 20. insulin lispro 100 unit/ml cartridge sig: one (1) subcutaneous four times a day: as directed per sliding scale. 21. heparin flush 10 unit/ml kit sig: ten (10) ml flush intravenous once a day as needed for 10 days: sash and prn. disp:*30 syringes* refills:*0* 22. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 23. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 24. saline flush 0.9 % syringe sig: one (1) injection once a day as needed for as needed for picc line. disp:*30 qs* refills:*0* discharge disposition: home with service facility: uphams corner home care discharge diagnosis: 1' diagnosis diabetic ketoacidosis coagulase negative staph bacteremia 2' diagnosis diabetes mellitus grave's disease hypertension discharge condition: afebrile, vital signs stable, tolerating good pos discharge instructions: you were admitted with a diagnosis of diabetic ketoacidosis and bacteremia. you were in the icu briefly requiring an insulin drip and iv fluids. your ketoacidosis resolved. you are going to be treated for the bacteremia with a total of 14 days of vancomycin. . you also were found to have blood in your stools. you have been started on a proton pump inhibitor. you should follow up as with dr. as for further evaluation. . please take your medications as directed. . please return to the hospital or call your pcp if you experience any of the following symptoms: fever > 101, chest pain, shortness of breath, decreased oral intake, elevated blood sugars, or any other symptoms not listed here concerning enough to warrant physician . followup instructions: please follow up with your primary care physician : , . on at 7:00pm. . with dr. at diabetes center within the next weeks. . rheumatology: provider: , md phone: date/time: 11:00 . neurology: provider: . & phone: date/time: 2:30 . gastroenterology/hepatology: provider: , md phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of other (naso-)gastric tube diagnoses: esophageal reflux unspecified essential hypertension acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma asthma, unspecified type, unspecified polyneuropathy in diabetes depressive disorder, not elsewhere classified other and unspecified hyperlipidemia bacteremia other constipation nonspecific abnormal findings in stool contents toxic diffuse goiter without mention of thyrotoxic crisis or storm staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus migraine, unspecified, without mention of intractable migraine without mention of status migrainosus diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled gastroparesis other specified arthropathy, site unspecified 

Answer: The patient is high likely exposed to