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: no known allergies / adverse drug reactions attending: chief complaint: anemia major surgical or invasive procedure: hd line removal femoral line placement in the ed & removal new tunneled hd line placement history of present illness: patient is 64 year old male with a complex past medical history, including esrd on hd (mwf), chronic aspiration, seizure disorder, history of cva with residual left-sided weakness and dysarthria, upper extremity dvt on coumadin who was brought in from home by ems with dark stools. per daughter, he states his back was hurting yesterday, gave 2 tylenol. today, he also stated his back was hurting. he came back from dialysis, had large bm, looked dark with some blood in it. the patient's family was concerned and they noted dark tarry-looking stools per the ems report. on arrival to the ed, initial vitals were 98.9 117 111/70 18 98% 4l. he was slightly somnlent, but arousable and oriented x 3. initial hct was 33.8, then 31.3, last hct on file was 36 in . inr was 5.7. ecg showed sinus 113, twi ii, , avf, v5, v6 c/w prior. on rectal exam, stools were dark and guiac positive with some bloody red streaks. gi was called, recommended starting pantoprazole. he received 10 vitamin k, protonix, 1 unit ffp. a right groin line was placed as access was difficult. ngl was negative with "poor return." vitals on transfer were 111 106/73 21 97% 2l nc. on arrival to the micu, patient was is somnolent, but arousable to voice, following commands. his glucose was noted to be 58, and he was given an amp of dextrose. per his daughter, he is usually much more somnolent on dialysis days. also of note, on last admission, he was somnolent and hypoglycemic. endocrine was consulted and felt that his hypoglycemia was secondary to poor po intake and impaired gluconeogenesis from esrd. past medical history: - esrd on hd (m/w/f at ) - h/o multiple prior cvas - per last dc summary ambulates at home, has residual left-sided weakness - ue dvt on coumadin - seizure disorder - chronic hepatitis b - chronic aspiration with failed speech and swallow eval - family wants him to continue eating despite risks - htn - cad - h/o mssa bacteremia after manipulation of fistula - hospitalization in for incarcerated inguinal hernia complicated by esbl klebsiella bacteremia and pna - hyperlipidemia - gerd - s/p sbo - hernia repair - symptomatic hypoglycemia social history: patient lives in with his daughter, , who is a former employee. he denies any recent use of alcohol, tobacco, illicit drugs, or herbal medications. he has a distant, but considerable smoking history per his daughter. uses the toilet himself, but needs help cleaning himself, and does not cook or manage his finances. he is at hd on mwf and spends tu and in an adult day program. his daughter does not leave him alone by himself. family history: mother died at 45 with hypertension. father died at 60 of unknown causes. he has eight living siblings, many of whom have hypertension. he has six children who are all healthy. physical exam: admission physical exam: vitals: t: 98.6 bp: 145/61 p: 104 r: 20 o2: 95%ra general: , orientedx3, no acute distress, dysarthric : sclera anicteric, mmm, oropharynx clear, , perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, on the right side, residual weakness on the left side, grossly normal sensation, gait deferred, finger-to-nose intact physical exam: vitals: tc 99.3 tmax 99.3 bp: 110/68 (110-120'/60-70') p: 99 (90-100') r: 16 o2:95%ra general: , orientedx3, no acute distress, dysarthric : sclera anicteric, mm relatively moist, oropharynx clear, , perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, on the right side, residual weakness on the left side, grossly normal sensation, gait deferred, finger-to-nose intact pertinent results: admission labs: =============== 04:45pm blood wbc-8.8 rbc-3.16* hgb-10.6* hct-33.8* mcv-107*# mch-33.6*# mchc-31.5 rdw-15.8* plt ct-156# 04:45pm blood neuts-74.7* lymphs-14.7* monos-8.0 eos-1.6 baso-1.1 06:25pm blood pt-57.3* ptt-73.9* inr(pt)-5.7* 04:45pm blood glucose-99 urean-39* creat-6.8* na-140 k-5.0 cl-99 hco3-27 angap-19 02:45am blood calcium-8.4 phos-4.6* mg-1.5* 08:00am blood vanco-17.8 05:02pm blood lactate-1.7 labs: =============== 06:30am blood wbc-7.6 rbc-2.79* hgb-9.0* hct-28.4* mcv-102* mch-32.4* mchc-31.8 rdw-17.6* plt ct-178 06:30am blood pt-12.9* ptt-30.9 inr(pt)-1.2* 06:30am blood glucose-84 urean-53* creat-9.1*# na-140 k-4.8 cl-99 hco3-23 angap-23* 06:30am blood calcium-9.3 phos-4.6* mg-1.7 06:30am blood vanco-20.5* microbiology: ============= blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient catheter tip-iv femoral - final inpatient - no significant growth catheter tip-iv hd line - final inpatient - no significant growth blood culture blood culture, routine- gpc in pairs and clusters, final report pending serology/blood helicobacter pylori antibody test-final inpatient - negative mrsa screen mrsa screen-final inpatient - negative 5:00 pm blood culture **final report ** blood culture, routine (final ): this is a corrected report . reported to and read back by ara tachjian # 8:35am. staphylococcus epidermidis. previously reported as (on ). staph aureus, presumptive identification, to j. @ 11:02am. final sensitivities. 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 epidermidis | clindamycin-----------<=0.25 s erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ 2 s imaging: ======== portable cxr: findings: a central venous catheter terminates in the right atrium, as before. the cardiac, mediastinal and hilar contours appear unchanged. patchy opacity along the left hemidiaphragm suggests minor atelectasis. the right mid lung opacity has resolved. post-traumatic changes along the distal right clavicle appears similar. echo: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the mid inferior and distal segments. overall left ventricular systolic function is low normal (lvef 50-55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: biatrial enlargement. normal left ventricular cavity size and wall thickness with low-normal global left ventricular systolic function and regional wall motion abnormalities as described above. no clinically significant valvular regurgitation or stenosis. indeterminate pulmonary artery systolic pressure brief hospital course: 64 year old male with a complex past medical history, including esrd on hd (mwf), chronic aspiration, seizure disorder, history of cva with residual left-sided weakness and dysarthria, upper extremity dvt on coumadin (on hold during this admission), presented with gi bleed (black stool, fobt positive) in the setting of supratherapeutic inr and coagulase negative gpc blood cultures concerning for endovascular infection (oxacillin resistant staph epidermidis sensitive to vancomycin), possible source hd line, discharged on course of iv vancomycin through . # anemia: patient presented with dark guaiac positive stools and hct drop on admission along with mild tachycardia. he received 1 unit prbcs while in the icu where he was admitted for further observation (resulted in hct being stable at 25-27) and inr reversed with ffp and vitamin k. egd showed gastritis, no active bleeding lesions. h pylori serology was negative. he was transferred to medical floor in stable condition and was continued on pantoprazole twice daily and hct remained stable. outpatient colonoscopy can be considered to complete work up. coumadin was held on . aspirin was continued. # positive blood cultures: gpc on culture drawn on admission (unclear if through line). reportedly was growing gpcs at dialysis and had been started on vancomycin with plan to complete course of 2 weeks through . all cultures so far (, , ) grew coagulase negative staphylococcus (s epidermidis). blood culture showing so far gpc without further speciation. the hd line was removed on in addition to the femoral that was placed in the ed on presentation given difficult access (tips of both were sent for microbiology and did not show growth on final report). id team was involved and the patient was discharged on iv vancomycin dosed per hd protocol for 2 weeks from th day of removing the hd line, that is, through . tte was done which didn't show vegetations. id team was involved in his care. there was a discussion with id about tee however this was not performed given the growing organism is more likely to be related to hd line. # dvt: patient was on coumadin on admission for upper extremity dvt, clot in avf. his inr on admission was 5.7 and received 2u ffp on admission to reverse the inr. coumadin was held throughout the hospital stay and upon . this can be re-evaluated by the primary care physician as outpatient whether to restart or not. he might need outpatient colonoscopy to further evaluate anemia. # esrd: patient on dilaysis, received session and . the dialysis on was performed after a new hd tunneled line was placed (he was given "line holiday" in between). # hypertension: initially anti-hypertensives were held. lisinopril 40 mg daily was eventually restarted since hemodynamically was stable and hct was stable along with hypertension. we continued to hold amlodipine and metoprolol while in the hospital. # altered mental status and hypoglycemia: hypoglycemia thought to be secondary to poor nutrition and impared gluconeogenesis. he required iv d5% while in the icu. this has normalized prior to transfer to medical floor and maintain good level of blood glucose while on the medical floor without the need for iv d5%. transitional issues: - please evaluate restarting amlodipine/metoprolol if possible/neccessary - please evaluate if still needs to be on anti-coagulation - outpatient colonoscopy - coumadin held throughout admission and - asa was held, restarted on - new hd tunneled line was placed on - iv vancomycin per hd protocol through per id recommendations - f/u final report of and blood culture - code status: full medications on admission: amlodipine - (on hold from to unknown for unclear if needed) - 5 mg tablet - 1 tablet(s) by mouth at bedtime b complex-vitamin c-folic acid - 1 mg capsule - 1 capsule(s) by mouth once a day lanthanum - 500 mg tablet, chewable - 1 tablet(s) by mouth with meals levetiracetam - 500 mg tablet - 3 tablet(s) by mouth twice a day this rx replaced the one sent yesterday lisinopril - (on hold from to unknown for unclear if needed) - 40 mg tablet - 1 tablet(s) by mouth once a day metoprolol tartrate - (on hold from to unknown for unclear if needed) - 50 mg tablet - 2 tablet(s) by mouth twice a day omeprazole - 20 mg capsule, delayed release(e.c.) - 2 capsule(s) by mouth twice a day polyethylene glycol 3350 - 100 % powder - 17 grams by mouth once a day as needed for constipation, dispense for 30-day supply pravastatin - 40 mg tablet - 1 tablet(s) by mouth daily sevelamer hcl - 400 mg tablet - 2 (two) tablet(s) by mouth three times a day with meals warfarin - 6 mg tablet - take up to 1 tablet(s) by mouth daily or as directed by coumadin clinic warfarin - 1 mg tablet - take up to 10 tablet(s) by mouth once a day or as directed by coumadin clinic warfarin - 2 mg tablet - asdir tablet(s) by mouth asdir take as directed by coumadin clinic medications - otc ascorbic acid - 500 mg tablet - 1 tablet(s) by mouth daily (daily) aspirin - 81 mg tablet, chewable - 1 tablet(s) by mouth daily (daily) blood sugar diagnostic - strip - use as directed for blood sugar monitoring three times a day and as needed docusate sodium - 60 mg/15 ml syrup - 10 ml by mouth po bid docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day as needed for constipation lancets - misc - use as directed for blood sugar monitoring three times a day and as needed sennosides - 8.6 mg tablet - 1 (one) tablet(s) by mouth twice a day as needed for constipation thickening , topical no.1 - liquid - tbsp tid with meals as needed dx: oral dysphagia icd9: 787.21 medications: 1. nephrocaps 1 cap po daily 2. lanthanum 500 mg po tid w/meals 3. levetiracetam 1500 mg po bid 4. lisinopril 40 mg po daily hold for sbp<100 5. omeprazole 40 mg po bid 6. polyethylene glycol 17 g po daily:prn constipation 7. pravastatin 40 mg po daily 8. sevelamer carbonate 800 mg po tid w/meals 9. docusate sodium 100 mg po bid hold for loose stools 10. senna 1 tab po bid:prn constipation 11. vancomycin 1000 mg iv hd protocol rx *vancomycin 1 gram per hd protocol disp #*8 vial refills:*0 12. aspirin 81 mg po daily disposition: home with service facility: vna diagnosis: primary diagnoses: coagulase negative staph bacteremia upper gi bleeding transient hypoglycemia end stage renal disease on dialysis condition: mental status: clear and coherent. level of consciousness: and interactive. activity status: bedbound. activity status: out of bed, will require assistance to chair instructions: dear mr. , it was a pleasure taking care of you. as you know you were admitted to because of black stools. it was found that your blood level was low and you received 1 bag of red cells as blood transfusion. you had an upper gi scope which showed inflammation of the stomach. you were started on acid suppressing medication. you were admitted to the icu for monitoring given your heart rate was fast. your blood levels remained stable as well as your vital signs. we did not give you coumadin for your upper extremity clot given the risk of bleeding. you were transferred to the medical floor since your vital signs remained stable. please discuss this with your primary care physician regarding restarting it and whether or not colonoscopy as outpatient would be necessary as part of the work up. regarding the bacteria in your blood, your older dialysis line was removed on and a new one was placed on through which you had your dialysis as scheduled. we made the following changes in your medication list: -please continue iv vancomycin dosed based on dialysis protocol for a course of 2 weeks from through . -please hold coumadin till you see your primary care physician hold amlodipine and metoprolol. discuss about restarting these with your primary care physician please continue the rest of your home medications the way you were taking them at home prior to admission. please follow with the appointments as illustrated below. followup instructions: ********* please call on your primary care physician's office reachable at to schedule a follow up appointment in the next 1-3 days. department: neurology when: thursday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis diagnoses: end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery esophageal reflux acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure bacteremia other late effects of cerebrovascular disease long-term (current) use of anticoagulants epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta hypoglycemia, unspecified other specified gastritis, with hemorrhage bloodstream infection due to central venous catheter muscle weakness (generalized) late effects of cerebrovascular disease, dysarthria 

Answer: The patient is high likely exposed to