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 / codeine / heparin agents / levofloxacin attending: chief complaint: ongoing hypotension, hypothermia, anasarca, and inability to tolerate hd for fluid removal major surgical or invasive procedure: tunnelled left internal jugular hemodialysis catheter left femoral hemodialysis catheter right femoral triple lumen catheter left picc line debridement of sacral decubitus history of present illness: ms. was admitted on for surgery evaluation of right heel ulcer. she was started on vanco/cipro/flagyl on admission to cover an infection. on hospital day 2 (), she underwent right peroneal angioplasty on and was put on an argatroban drip for 24 hours following the procedure. on , she was noted to be hypotensive to 72/37 and hypothermic to 94.6. cardiac enzymes were checked and were noted to be positive. she was transfused 2 units packed red blood cells on . plastic surgery was consulted for evaluation of sacral decubuti, but declined to debride wound due to aspirin/plavix/argatroban use. she underwent hd on , but they were unable to remove fluid due to low blood pressures. when renal evaluted her on that day, there was concern that her mental status was not at baseline and her words were not well enunciated. they recommended sending blood cultures and broadening antibiotics but no intervention was undertaken at this time. cardiology was consulted on for bradycardia, hypotension, and elevated cardiac enzymes and recommended discontinuation of beta-blockers. an echo was performed on which showed new regional wall motion abnormalities. given hypotension, anasarca, and inability to tolerate hd due to low blood pressures, patient was transfered to micu for cvvhd. . upon arrival to the micu, patient reports right hand pain. she denies any other complaints. no abdominal pain, nausea, vomiting, diarrhea, fevers, chills, shortness of breath, chest pain. past medical history: type 2 dm esrd on hd tue/thurs/sat cad s/p mi in and , s/p cabg x 2 diagstolic chv (ef 60-65%0 paf (not anticoagulated due to gi bleeds) htn hypothyroidism anemia of chronic disease thrombocytopenia hit in h/o mrsa endocarditis chronic gi bleeds due to avms pud, barrett's asthma psh: cabg x 2 cholecystectomy bso -- patient with uterus on ct scan 11/08 l bka social history: the patient is primarily spanish speaking but does speak fair english. she is wheelchair bound and lives in a . the patient is widowed, a retired factory worker. tobacco: none etoh: none illicits: none family history: cad, htn, and dm physical exam: tcurrent: 36.2 ??????c (97.2 ??????f)hr: 66 bpm bp: 72/28(38)rr: 22 spo2: 92% ra physical examination general appearance: well nourished, obese, anasarcic eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal) peripheral : (right radial pulse: dopplerable), (left radial pulse: dopplerable), (right dp pulse: dopplerable), (left dp pulse: not assessed) respiratory / chest: (breath sounds: clear : anteriorly) abdominal: soft, non-tender, bowel sounds present, obese extremities: right: 3+, left: 3+, right heel ulcer, left bka skin: sacral decub, bilaterial ischial decubiti, right heel ulcer, rue erythema/warmth . on discharge tcurrent: 36.6 ??????c (97.8 ??????f)hr: 69 bpm bp: 80/40 mmhg rr: 21 insp/min, spo2: 96% ra wgt (current): 79.5 kg (admission): 112.5 kg, dry 78.5 kg general appearance: well nourished, overweight / obese eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: no(t) systolic) peripheral : (right radial pulse: diminished), (left radial pulse: diminished), (right dp pulse: diminished), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) abdominal: soft, bowel sounds present, no(t) tender: extremities: right: trace, left: trace musculoskeletal: unable to stand skin: warm, rash: right arm remains with ischemic blisters, less tender. sacral and ischial decubiti - stage iii neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): self, location, movement: spontaneous pertinent results: transfer to unit: 06:00am blood wbc-27.7*# rbc-3.33* hgb-10.5* hct-30.9* mcv-93 mch-31.4 mchc-33.9 rdw-18.5* plt ct-173 06:00am blood neuts-89.7* lymphs-4.0* monos-5.5 eos-0.4 baso-0.3 06:00am blood pt-19.7* ptt-38.1* inr(pt)-1.8* 06:00am blood glucose-81 urean-24* creat-2.9* na-130* k-4.0 cl-96 hco3-24 angap-14 06:00am blood alt-13 ast-25 ld(ldh)-247 alkphos-212* totbili-1.1 05:06pm blood calcium-8.2* phos-1.7* mg-1.6 . iron studies 08:20am blood caltibc-113* ferritn-488* trf-87* iron-26* 09:00am blood caltibc-104* trf-80* iron-39 . cardiac markers 03:37am blood ck-mb-notdone ctropnt-0.20* 09:00am blood ck-mb-notdone ctropnt-0.20* 04:30pm blood ck-mb-notdone ctropnt-0.15* . tfts 12:23am blood tsh-3.7 12:23am blood t4-3.4* . cortisol stem test 07:43am blood cortsol-17.0 08:54am blood cortsol-24.8* . inflammatory markers 11:48am blood esr-55* 04:07am blood esr-109* 03:00am blood crp-177.2* 04:07am blood crp-55.2* 06:39am blood lactate-4.0* 05:07am blood lactate-2.3* . radiology echo : ef 55%, normal left ventricular cavity size with regional systolic function most c/w cad. mildly dilated rv with mild global hypokinesis. mild pulmonary arterial systolic hypertension. mild mitral regurgitation. . right heel : findings: comparison is made to prior radiographs from . there is no soft tissue gas or large ulceration within the right posterior heel. there are large plantar spur which is unchanged since study. extensive calcifications are seen. there is no bony destruction to indicate acute osteomyelitis. there is overall demineralization of the bony structures. . right ue veins 11/25, no evidence of deep venous thrombosis. patent av fistula, right antecubital fossa. . right arm arterial dopplers : findings as stated above which indicate poor right radial artery flow with improvement with compression. note of radial artery calcification. calcifications are new when compared to a prior av fistula study performed in . . right forearm interstitial edema. no evidence of abscess. . ct abdomen/pelvis : impression: 1. soft tissue wound inferior to the coccyx, with induration and inflammatory changes within the subcutaneous fat extending to the rectum, with inflammatory changes involving the posterior wall of the rectum. 2. 4.3 cm fat-containing anterior abdominal wall lesion, consistent with a fat-containing hernia, not significantly changed in size compared to with a focus of central hyperdensity which may represent an engorged vessel. 3. fractures of the right lateral ninth and eighth ribs. 4. a 15 mm cystic lesion inferior to the pancreatic head, which may represent a side branch ipmn or other mucinous lesion, for which further evaluation with mrcp is recommended. 5. nodular appearance of the liver surface, consistent with cirrhosis. 6. anasarca and ascites. 7. left inguinal lymphadenopathy, with a single prominent node measuring up to 11 mm in short axis diameter. . transvaginal ultrasound : the patient is post-menopausal. transabdominal examination is significantly limited due to large patient body habitus and poor echo penetration. transvaginal examination was attempted; however, due to the patient's condition she had difficulty complying with endovaginal ultrasound probe maneuvers. . picc :uncomplicated ultrasound and fluoroscopically guided 5 french double-lumen picc line placement via the left brachial venous approach. final internal length is 41 cm, with the tip positioned in svc. the line is ready to use. . non-tunneled lij hd : uncomplicated placement of left-sided 12-french 20-cm triple lumen temporary hemodialysis catheter via the left internal jugular vein. . discharge labs: wbc rbc hgb hct mcv mch mchc rdw plt ct 03:48am 13.6* 2.75* 8.9* 25.8* 94 32.3* 34.4 20.1* 74* renal & glucose glucose urean creat na k cl hco3 angap 03:48am 115* 28* 3.9* 127* 4.7 90* 25 17 brief hospital course: ms. is a 78 year old female with type 2 dm, esrd on hd, pvd s/p bka, cad s/p mi with septic shock, volume overload. . 1. septic shock: due to mdr acinetobacter line infection and resolved. had initially been treated empirically with daptomycin, colistin, flagyl and unasyn. daptomycin and flagyl were discontinued as there were no gram positive bacteria in blood cultures, and negative c. difficile x 3. acinetobacter coverage narrowed to high dose unasyn to complete a 14-day course from the date of the first negative blood culture. unasyn day 1=, to complete . . 2. hypotension: baseline sbp 70s-80s per the renal team that follows her as an outpatient; suspect bad pvd preventing accurate measurement of true bp. the patient mentates well at this blood pressure. we initiated midodrine and this was continued for discharge. . 3. sacral /ischial decubiti: plastic surgery debrided the sacral ulcer. given rise in esr from 55 to 109, were are treating for now for presumptive osteomyelitis. she should continue vancomycin and ceftazidine for a two-week course and monitor esr. if esr persists high, discuss continuation of antibiotics with plastics. the patient has follow-up scheduled with plastic surgery. . 5. end-stage renal disease on hemodialysis: patient negative 30l on cvvhd during her admission to the micu, and she is felt to be near her dry weight. patient is tolerating hd. continuing midodrine as above. . 6. right arm pain: there is some steal from her av fistula, but no current change in management is recommended at this time after consultation with the hand surgeons. her neuropathic pain is improved. she has a good radial pulse currently. further consideration of neurontin or other treatments may be appropriate after discharge. . 7. anemia: history of chronic gi bleed from avms. we targeted a hct of 25 for transfusion and recommend follow-up monitoring for signs of gi bleeding. . 8. heel ulcer/peripheral disease: status post right peroneal angioplasty on . continued weight-sparing boot. the patient has follow-up scheduled with surgery. . 8. thrombocytopenia: she has a history of thrombocytopenia and her counts are stable at discharge. the patient has a history of heparin-induced thrombocytopenia and therefore heparin was avoided and heparin-free lines only were used. . 9. type 2 diabetes: we continued sliding scale insulin and stopped her fixed dose 70/30 in setting of hypoglycemia. . 11. elevated inr: likely nutritional and somewhat improved with vitamin k 5 mg po x 3 days. . 12. vaginal bleeding: the patient had a small amount of vaginal bleeding during admission. she has a uterus and cervix, but ct scan and transvaginal ultrasound with limited views show no pathologic features. further evaluation is deferred to the outpatient setting. medications on admission: home meds: 1. acetaminophen 2. albuterol mdi 3. asa 4. colace 5. advair diskus (250/50) 6. synthroid 7. metoprolol xl 8. neutra-phos 9. pantoprazole 10. simvastatin . medications on transfer: carbamide peroxide ear drops vancomycin d1 = insulin ss toprol 12.5 xl silver sulfadiazine hydromorphone prn aspirin 81 mg daily plavix 75 mg daily flagyl 500 q 8, d1 = cipro 500 mg daily, d1 = colace fluticasone/salmeterol simvastatin 40 mg daily pantoprazole 40 mg daily levothyroxine 175 daily albuterol prn discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: severe sepsis d/t acinetobacter bacteremia sacral decubitus, stage iii bilateral ischial decubiti, stage ii end stage renal disease requiring cvvhd osteomyelitis of sacrum discharge condition: stable, afebrile, 98% ra, sbps 80/40 discharge instructions: you were admitted for revascularization of your right leg. you developed a blood infection that is being treated with antibiotics. for a time you required medications to support your blood pressure. you underwent continuous hemodialysis to remove 30 liters of extra fluid. you also came in with a dead tissue covering an ulcer that needed to be removed. the dead tissue and fat were removed from your sacrum and you were started on antibiotics to treat a potential bone infection related to your ulcer. you improved on antibiotics and have resumed normal hemodialysis. you are ready to go to a rehabilitation facility to continue your recovery. you will need to complete all your antibiotics. you have a special intravenous line called a picc to allow you to receive these antibiotics. you will continue to receive hemodialysis at your rehabilitation facility. you have been started on a new medication midodrine to help support your blood pressure. if you experience temperature < 95.0 f, or > 101.5, chest pain, inability to breath, or any other concerning symptoms please go to the emergency department. followup instructions: you will receive hemodialysis on monday/wednesday/friday. follow-up with plastic surgery: provider: surgery clinic phone: date/time: 02:30pm location: , , building . follow-up with surgery: ,, md phone: date/time: 12:50pm location: , , medical building, . follow-up with primary care: , md phone: date/time: 02:00pm location: , , building . procedure: hemodialysis angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries venous catheterization for renal dialysis excisional debridement of wound, infection, or burn transfusion of packed cells removal of other device from thorax procedure on single vessel diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified pleural effusion congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia severe sepsis atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified cardiac dysrhythmias diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled other specified septicemias septic shock pressure ulcer, other site pressure ulcer, lower back infection and inflammatory reaction due to other vascular device, implant, and graft kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution atherosclerosis of native arteries of the extremities with gangrene diastolic heart failure, unspecified barrett's esophagus diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status other specified noninflammatory disorders of vagina ulcer of heel and midfoot angiodysplasia of stomach and duodenum with hemorrhage pressure ulcer, stage ii unspecified osteomyelitis, pelvic region and thigh pressure ulcer, stage iii personal history of methicillin resistant staphylococcus aureus subclavian steal syndrome pressure ulcer, unstageable unspecified local infection of skin and subcutaneous tissue 

Answer: The patient is high likely exposed to