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: captopril attending: chief complaint: right leg ischemia and infection major surgical or invasive procedure: r below-knee amputation and excision of infected closure of r bka site and groin incisions incision and drainage, right common femoral to above knee popliteal removal right groin washout, sartorius flap placement, vac-placement right ij tunnel catheter history of present illness: 64m well known to the vascular service s/p recent discharge from our service on after pta rcia and stent rcia, then a redo femoral to posterior tibial artery bypass with ptfe, who presented with leukocytosis to 26, nausea, emesis and ischemic right leg. pt was seen by dr. for discussion regarding failed bypass and need for amputation. he was sent home and felt well until this am when he was hypoglycemic to the 60s and nauseous. he vomited foodstuff x3 and called the ambulance. he was initially evaluated at , where he complained of mild abdominal pain. + bm this am, nn diarrhea, no abx use,+ fevers and chills x 24hrs. no sputum production, no dysuria, patient states he has been making the usual amount of urine. no pain over kidney nor over vascular site. patient denies pain at rle, but states that the mottling of rle is worse. sensation in rle is intact and there is no weakness. he was also noted to have minimal drainage from the medial portion of his wound, stable for a few days, no foul smell. temperature on arrival to osh 102.6 hr 110 with bp 150/ 58. he was found to have a leukocytosis to 26.7 w 13 bands at osh. vancomycin, cipro and flagyl given to patient prior to transfer. past medical history: hypertension, congestive heart failure (ef 25-30%) coronary artery disease, s/p mi , pvd, diabetes type 2, esrd s/p renal transplant , history of mrsa bacteremia past surgical history: : cabgx3 : right common femoral artery to above knee popliteal with nonreverse greater saphenous vein : left upper arm a-v fistula : left femoral to above popliteal bypass with ptfe : renal transplant () : left common femoral artery to below-knee popliteal artery bypass with polytetrafluorethylene(ptfe). : re-do right femoral to below knee popliteal bypass with ptfe : right lower extremity arteriogram with balloon angioplasty of right common iliac artery and stent placement at right common iliac artery : redo femoral to posterior tibial artery bypass with ptfe social history: married, lives in with wife, quit smoking , denies etoh/ilicit drugs family history: dm2 - maternal & external, cad - maternal (both deceased) physical exam: on admission: vs: 99.3 96 133/65 18 98% ra gen: nad, a&ox3, uncofortable c/o back pain, flushed, very warm to touch cvs: rrr pulm: clear anteriorly abd: soft, nd, mild tenderness in llq no rebound, no guarding. no cva tenderness. ext: rle with mottling and cyanosis foot, delayed cap refill. motor intact, sensation intact bilaterally. medial distal thigh with 0.3 cm opening with trace brown fluid, no fluctuance, no collections palpated no erythema of thigh. trace calf erythema with blanching, no edema. dry gangrene 1rst and 2nd digits. pulses: right and left femoral palp. bilateral popliteal signals. no signals on the right dp and pt, + signals left dp and pt pertinent results: 06:35pm lactate-3.1* 07:00pm pt-29.4* ptt-31.2 inr(pt)-2.9* 07:00pm neuts-84* bands-13* lymphs-2* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 07:00pm wbc-30.7*# rbc-3.90* hgb-11.3* hct-33.2* mcv-85 mch-29.0 mchc-34.1 rdw-14.9 07:00pm calcium-9.8 phosphate-2.6* magnesium-1.5* 07:00pm glucose-258* urea n-49* creat-1.8* sodium-133 potassium-4.2 chloride-96 total co2-20* anion gap-21* 10:11pm lactate-3.4* 08:10am blood wbc-24.9* rbc-3.76* hgb-11.0* hct-32.9* mcv-88 mch-29.3 mchc-33.5 rdw-15.4 plt ct-192 03:00am blood wbc-22.0* rbc-3.63* hgb-10.4* hct-31.2* mcv-86 mch-28.6 mchc-33.2 rdw-15.0 plt ct-168 07:52pm blood wbc-17.6* rbc-3.16* hgb-9.0* hct-26.6* mcv-84 mch-28.4 mchc-33.8 rdw-14.9 plt ct-166 06:00am blood wbc-15.5* rbc-3.31* hgb-9.4* hct-28.0* mcv-85 mch-28.5 mchc-33.7 rdw-14.9 plt ct-159 03:45am blood wbc-14.3* rbc-3.53* hgb-10.1* hct-29.4* mcv-83 mch-28.5 mchc-34.2 rdw-16.0* plt ct-179 06:07pm blood wbc-14.3* rbc-3.46* hgb-9.9* hct-29.1* mcv-84 mch-28.7 mchc-34.2 rdw-16.3* plt ct-198 03:26am blood wbc-12.6* rbc-3.40* hgb-9.2* hct-28.6* mcv-84 mch-27.1 mchc-32.2 rdw-16.5* plt ct-201 06:15am blood wbc-12.2* rbc-3.50* hgb-9.8* hct-29.8* mcv-85 mch-27.8 mchc-32.7 rdw-16.3* plt ct-222 09:00am blood wbc-12.1* rbc-3.68* hgb-10.0* hct-31.0* mcv-84 mch-27.1 mchc-32.3 rdw-16.7* plt ct-282 04:40am blood wbc-12.7* rbc-3.68* hgb-10.2* hct-30.6* mcv-83 mch-27.8 mchc-33.4 rdw-16.8* plt ct-286 06:30am blood wbc-11.9* rbc-3.79* hgb-10.5* hct-32.4* mcv-86 mch-27.6 mchc-32.3 rdw-16.7* plt ct-337 08:10am blood glucose-162* urean-39* creat-1.4* na-136 k-4.4 cl-101 hco3-19* angap-20 06:30am blood glucose-200* urean-34* creat-1.6* na-129* k-4.8 cl-95* hco3-20* angap-19 08:10am blood ck-mb-18* ctropnt-0.13* 07:30pm blood ck-mb-17* mb indx-2.9 ctropnt-0.28* 03:00am blood ck-mb-12* mb indx-1.7 ctropnt-0.34* 08:10am blood tacrofk-4.1* 06:30am blood tacrofk-8.9 6:10 pm blood culture blood culture, routine (final ): staph aureus coag +. 9:00 am blood culture set 2. **final report ** blood culture, routine (final ): staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus and species. final sensitivities. this isolate is presumed to be resistant to clindamycin based on the detection of inducible 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 _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 4:00 pm swab site: groin right groin. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): staph aureus coag +. sparse growth. of two colonial morphologies. 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. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): no fungus isolated. 4:00 pm swab site: leg right thigh . gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs, chains, and clusters. wound culture (final ): staph aureus coag +. sparse growth. 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. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=0.5 s anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): no fungus isolated. 2:53 pm blood culture source: line-cvl. blood culture, routine (final ): no growth. 5:45 pm blood culture blood culture, routine (final ): no growth. ct abd/pelvis : 1. post surgical change in the right groin subjacent to superior aspect of recently placed femoral to posterior tibial . 2. bilateral common femoral to popliteal grafts and right femoral to posterior tibial are present, however, patency cannot be evaluated without contrast administration. 3. moderate diffuse atherosclerotic disease. 4. 4.4 x 4.0 cm infrarenal aortic aneurysm. abdominal x-ray : no previous images. bowel gas pattern is essentially within normal limits without evidence of obstruction or significant ileus. there are calcifications of the vas deferens bilaterally, suggesting the possibility of underlying diabetes. echo: very poor image quality.the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is probably moderately depressed (lvef= 35 %) with global hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the ascending aorta is mildly dilated. the aortic valve is not well seen. no aortic regurgitation is seen. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: very poor image quality. moderately depressed lvef (35%). compared to the prior report no definite change. us: impression: 1. minimally complex fluid in the left lower quadrant - consider ct if clinically warranted. 2. small pleural effusion. 3. no hepatobiliary abnormality detected. ct scan : impression: 1. no left lower quadrant fluid collection is seen. minimal free fluid in the abdomen without organized collection. 2. small bilateral pleural effusions with associated compressive atelectasis. 3. extensive atherosclerotic calcification of the aorta, coronary arteries, sma, and renal arteries. there is a 4.3-cm saccular infrarenal abdominal aortic aneurysm, unchanged compared to prior. 4. postoperative changes in the right groin. brief hospital course: patient was admitted to the vascular service and continued on vancomycin and zosyn. transplant nephrology was consulted for management of his immunosuppression and antihypertensives in the setting of sepsis. patient's coumadin was held and he was given vitamin k and started on a heparin drip. on , the decision was made the the patient's right leg was not salvageable due to critical ischemia, and he underwent a right below-knee amputation with excision of his prior . refer to dr. note for further details. the stump, thigh, and groin incisions were left open and packed, due to tissue and blood cultures positive for mrsa, and a jp drain was placed. blood cultures obtain on and since have been negative. patient was transferred stable and extubated to the pacu and then to the vicu. patient received 1 u prbcs for an hct of 26.6, with increase to 28.0. the heparin drip was discontinued. due to patient's prior cardiac history, including a bypass and mi, serial troponins and ekgs (showing non-specific st-t abnormalities) were obtained. troponins range from 0.33 to 0.44. patient was asymptomatic for chest pain and shortness of breath. on home cellcept was restarted and antihypertensives were reintroduced. patient received 1 unit of prbcs for an hct of 25.9 with increase to 29.4. cardiology was consulted and felt troponin elevation was due to demand ischemia. home diltiazem was stopped and replaced with metoprolol. on patient went to the or for closure of his stump, thigh, and groin wounds after clearance from cardiology.patient was diuresed for fluid overload (h/o chf with ef 25-30%), with improvement in blood pressure. patient's confusion, present since admission, had resolved. since sodium has ranged between 129 to 132, with institution of fluid restriction to 1 l and holding of home chlorthalidone. on patient experienced nausea without vomiting. a cardiac workup and abdominal xray were negative. patient had loose stools without abdominal pain, but c diff antigen was checked and was negative. patient was evaluated by infectious disease for his bloodstream infection, with recommendations for 6 weeks of intravenous vancomycin. patient worked with physical therapy since his amputation. from a surgical and infectious perspective patient was doing very well. his amputation site was healing well. the erythema had decreased. he had no fevers and his wc and decreased to normal. however starting on he began to have a rise in his creatinine. his ace-i and lasix were stopped. urine lytes looked c/w decreased pre-load but ua looked c/w atn. gentle iv fluids were re-instated. tacrolimus level was elevated to 12 and with renal tx recommendations, dosing was decreased. on the patient had flash pulmonary edema and was transferred to the icu. he was stabilized on bipap. however, on he acutely became hypotensive and developed severe r thigh pain. zosyn was added empirically to his antibiotic regimen. a ct of the pelvis was done which revealed infection of his rle bypass , he was taken to the operating room emergently and the was resected. likely due to this second hypotensive insult, his transplant kidney stopped working. he was started on cvvhd and gradually transitioned to intermittent hd. his left upper extremity fistula was difficult to access because it was too deep, so a right ij tunneled dialysis line was placed by ir. a vac dressing was applied to his open thigh wound and eventually transitioned to wet to dry dressings. gastroenterology was consulted after he had several episodes of guaiac positive stools cdif was sent on multiple occasions but always returned negative. eventually he was extubated successfully and transferred to the vicu. psychiatry was consulted for his depressed affect and he was started on citalopram. nutrition became an issue, as his appetite was decreased due to depression and he could not tolerate tube feeding via a dobhoff. he was started on marinol and his po intake improved. he worked with physical therapy and it was determined that he needed acute rehab. he also had an egd on that was grossly normal. by the time of discharge his oral intake was improved. he was still getting intermittent dialysis three times a week. his mood was somewhat improved. his vital signs were stable. to note recieved four weeks zosyn, this was dc. he will remain on vancomycin untill follow-up with id. medications on admission: humalog ss/insulin detemir 30u am, coumadin 5mg (held) prograf 0.5 mg qam/ 0.5mg qpm, diovan 80mg daily diltiazem 30mg qid, isosorbide mononitrate 30mg daily lipitor 80mg daily, metolazone 2.5mg qmon lasix 80mg daily, aspirin 325mg daily cellcept 250mg , chlorthalidone 50mg discharge medications: 1. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 3. nystatin 100,000 unit/g cream : one (1) appl topical (2 times a day). 4. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical daily (daily) as needed for itching. 5. levothyroxine 25 mcg tablet : 0.5 tablet po daily (daily). 6. sodium chloride 0.65 % aerosol, spray : sprays nasal (2 times a day) as needed for stuffy nose. 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : four (4) inhalation q4h (every 4 hours) as needed for wheezes. 8. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours) as needed for wheezes. 9. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. 10. citalopram 20 mg tablet : one (1) tablet po daily (daily). 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for wheezing. 13. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for wheezing. 14. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed for yeast. 15. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain. 16. aspirin 325 mg tablet : one (1) tablet po daily (daily). 17. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). 18. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed). 19. dronabinol 2.5 mg capsule : two (2) capsule po bid (2 times a day). 20. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. 21. metoprolol tartrate 25 mg tablet : 0.5 tablet po q6h (every 6 hours). 22. midodrine 5 mg tablet : one (1) tablet po every other day (every other day). 23. tacrolimus 0.5 mg capsule : one (1) capsule po q12h (every 12 hours). 24. mirtazapine 15 mg tablet : 0.5 tablet po qhs (once a day (at bedtime)) as needed for for sleep. 25. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 26. mycophenolate mofetil 250 mg capsule : one (1) capsule po tid (3 times a day). 27. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 28. loperamide 1 mg/5 ml liquid : one (1) po tid (3 times a day). 29. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 30. heparin (porcine) 1,000 unit/ml solution : one (1) injection prn (as needed) as needed for line flush. 31. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 32. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 33. calcium gluconate 2 g iv prn ica<1.12 34. vancomycin 500 mg iv hd protocol 35. ondansetron 4 mg iv q8h:prn nausea 36. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 37. coumadin 1 mg tablet : one (1) tablet po once a day: md will adjust to keep inr . discharge disposition: extended care facility: - discharge diagnosis: infected occluded right femoral to posterior tibial artery bypass, s/p right bka mrsa sepsis s/p kidney transplant atn currently hd dependent hyponatremia cardiac demand ischemia atrial fibrillation, rate-controlled type 2 diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane) d/t r bka discharge instructions: you underwent a right leg below-knee amputation and excision for infection and thrombosis. during your hospital course, you received hemodialysis to facilitate your kidneys post-operatively/ this information is designed as a guideline to assist you in a speedy recovery from your surgery. please follow these guidelines unless your physician has specifically instructed you otherwise. please call our office nurse if you have any questions. dial 911 if you have any medical emergency. . activity: . there are restrictions on activity. on the side of your amputation you are non weight bearing until cleared by your surgeon. you should keep this amputation site elevated when ever possible. . you may use the other leg to assist in transferring and pivots. but try not to exert to much pressure on the amputation site when transferring and or pivoting. please keep knee immobilizer on at all times to help keep the amputation site straight. . no driving until cleared by your surgeon. . please call us immediately for any of the following problems: . redness in or drainage from your leg wound(s) . . watch for signs and symptoms of infection. these are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. if you experience any of these or bleeding at the incision site, call the doctor. . exercise: . limit strenuous activity for 6 weeks. . do not drive a car unless cleared by your surgeon. . try to keep leg elevated when able. . bathing/showering: . you may shower immediately upon coming home. no bathing. a dressing may cover you??????re amputation site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you will have sutures, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. . wound care: . an appointment will be made for you to return for staple removal. . when the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. these will stay on about a week and you may shower with them on. if these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . medications: . unless told otherwise you should resume taking all of the medications you were taking before surgery. you will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (check with your physician if you have fluid restrictions.) if you feel that you are constipated, do not strain at the toilet. you may use over the counter metamucil or milk of magnesia. appetite suppression may occur; this will improve with time. eat small balanced meals throughout the day. . cautions: . no smoking! we know you've heard this before, but it really is an important step to your recovery. smoking causes narrowing of your blood vessels which in turn decreases circulation. if you smoke you will need to stop as soon as possible. ask your nurse or doctor for information on smoking cessation. . avoid pressure to your amputation site. . no strenuous activity for 6 weeks after surgery. . diet : . there are no special restrictions on your diet postoperatively. poor appetite is expected for several weeks and small, frequent meals may be preferred. . for people with vascular problems we would recommend a cholesterol lowering diet: follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and ldl (low density lipoprotein-the bad cholesterol). exercise will increase your hdl (high density lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. you may be self-referred or get a referral from your doctor. . if you are overweight, you need to think about starting a weight management program. your health and its improvement depend on it. we know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. if interested you can may be self-referred or can get a referral from your doctor. . if you have diabetes and would like additional guidance, you may request a referral from your doctor. . follow-up appointment: . be sure to keep your medical appointments. the key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. don't let them go untreated! . please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. this should be scheduled on the calendar for seven to fourteen days after discharge. normal office hours are 8:30-5:30 monday through friday. . please feel free to call the office with any other concerns or questions that might arise followup instructions: call dr. office at ( to schedule an appointment to be seen in 2 weeks after discharge. 10:10a id,, lm , basement id west (sb) call to schedule an appointment with the transplant service (dr. . you will need your your av fistula superficialized once you are off antibiotics. you do not have aa cardiologist, you should make an appointment with a cardiogist regarding your new-onset atrial fibrillation. after rehab you should make an appointment with a psychiatrist in your area. you should follow up with nephrology at the procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other revision of vascular procedure other revision of vascular procedure insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis other surgical occlusion of vessels, lower limb arteries graft of muscle or fascia excisional debridement of wound, infection, or burn esophagogastroduodenoscopy [egd] with closed biopsy nonexcisional debridement of wound, infection or burn suture of artery other amputation below knee diagnoses: acidosis hyperpotassemia anemia in chronic kidney disease acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia hyposmolality and/or hyponatremia severe sepsis atrial fibrillation disruption of internal operation (surgical) wound aortocoronary bypass status aortic valve disorders personal history of tobacco use nausea with vomiting surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin blood in stool chronic systolic heart failure long-term (current) use of anticoagulants infection and inflammatory reaction due to other vascular device, implant, and graft urinary complications, not elsewhere classified atherosclerosis of native arteries of the extremities with gangrene leukocytosis, unspecified kidney replaced by transplant methicillin resistant staphylococcus aureus septicemia diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled peripheral angiopathy in diseases classified elsewhere other acute and subacute forms of ischemic heart disease, other atherosclerosis of autologous vein bypass graft of the extremities suicidal ideation adjustment disorder with depressed mood dysphagia, unspecified amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of antibiotics 

Answer: The patient is high likely exposed to