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: elective cholecystectomy major surgical or invasive procedure: open cholecystectomy history of present illness: history: mr. is well known to the acute care surgery service after being admitted on with acute cholecystitis and gallstone pancreatitis. on that day, he had a percutaneous cholecystostomy performed and was subsequently discharged on with a prolonged hospital course related to sepsis and delirium which has resolved. the patient also has multiple medical problems including hypertension, chronic renal failure, coronary artery disease, diabetes, and depression, takes diltiazem, protonix, zoloft, and lantus. he presents today for routine followup and discussion about possible cholecystectomy. the patient is anxious to have the tube removed as soon as possible. he denies pain in the area except for the drain site. he has been moving his bowels without difficulty and eating well. he is having some shortness of breath as his baseline, but otherwise, he seems to be making a slow recovery. past medical history: htn, crf, chf, dm-2 (requires insulin), depression, recent trauma (pedestrian struck) social history: nc family history: noncontributory physical exam: physical examination: operative vital signs: bp=140/71, hr=68, resp. rate 16 general: obese, nad cv: rrr lungs: rhonchi physical examination: pertinent results: 09:05am blood wbc-7.6 rbc-3.11* hgb-9.2* hct-28.7* mcv-93 mch-29.5 mchc-31.9 rdw-15.0 plt ct-505* 06:00am blood wbc-6.2 rbc-2.95* hgb-9.0* hct-27.3* mcv-92 mch-30.4 mchc-32.9 rdw-15.2 plt ct-507* 05:45am blood wbc-6.4 rbc-2.52* hgb-7.8* hct-23.5* mcv-93 mch-30.8 mchc-33.0 rdw-15.2 plt ct-397 05:50am blood wbc-7.1 rbc-2.62* hgb-8.0* hct-24.0* mcv-92 mch-30.4 mchc-33.1 rdw-14.9 plt ct-429 03:35pm blood neuts-70.1* lymphs-23.1 monos-3.7 eos-2.6 baso-0.5 09:05am blood plt ct-505* 06:00am blood plt ct-507* 05:45am blood plt ct-397 03:35pm blood pt-13.2 ptt-22.1 inr(pt)-1.1 05:10am blood urean-8 creat-1.0 na-134 k-3.8 cl-104 11:10am blood na-140 k-5.2* cl-107 09:05am blood glucose-112* urean-10 creat-1.0 na-138 k-5.2* cl-105 hco3-26 angap-12 05:45am blood glucose-99 urean-16 creat-1.2 na-142 k-3.7 cl-105 hco3-31 angap-10 02:33am blood alt-16 ast-32 alkphos-109 totbili-0.5 12:15pm blood alt-20 ast-33 alkphos-119 totbili-0.4 09:35pm blood ck(cpk)-272 12:50am blood ck-mb-3 ctropnt-0.02* 09:35pm blood ck-mb-3 ctropnt-0.04* 09:05am blood calcium-9.1 phos-2.6* mg-1.9 : ekg: sinus rhythm and frequent atrial ectopy. low precordial lead voltage. compared to the previous tracing of no diagnostic interim change. tracing : chest x-ray: findings: frontal and lateral views of the chest were obtained. there has been interval removal of the previously seen left picc line. opacification over the left costophrenic angle and inferior lateral left hemithorax may relate to overlying soft tissue and external artifact. however, a trace effusion, although not seen on the lateral view cannot be excluded, neither can atelectasis. the right lung is clear. the cardiac silhouette is top normal : chest x-ray: new interstitial abnormality at the lung bases and probable right pleural effusion are explained by cardiac decompensation. heart shadow and mediastinal vascular caliber are also increased. nevertheless, there is greater opacification in the right lower lung, which makes it difficult to exclude pneumonia. : chest x-ray: findings: in comparison with the study of , there are lower lung volumes. enlargement of the cardiac silhouette with pulmonary vascular congestion and probable bilateral pleural effusions are again seen. it is difficult to definitely exclude pneumonia in the absence of a lateral view. : echo: overall left ventricular systolic function is normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion appear to be normal . the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: sub-optimal study but -ventricular systolic function appear to be normal with no evidence of valvular pathology. : chest x-ray: mild-to-moderate pulmonary edema and moderate right pleural effusion have increased since . left lower lobe remains collapsed, and the larger left pleural effusion may have increased as well. cardiac silhouette is partially obscured, but may have increased in size. there is no pneumothorax. right subclavian line ends centrally. no pneumothorax. : chest x-ray: portable ap chest radiograph was reviewed in comparison to radiographs. the right internal jugular line tip is at the level of mid svc. the feeding tube tip is not included in the field of view but on the prior study demonstrated it to be in the stomach. bibasal opacities appear to be unchanged since the most recent prior radiograph. there is no interval increase in pleural effusion. there is no evidence of pulmonary edema but mild degree of vascular engorgement is still present, although improved since the prior radiograph. : ekg: normal sinus rhythm. non-specific st-t wave abnormalities. compared to the previous tracing of the underlying artifact has improved 4:31 pm sputum source: induced. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. pseudomonas aeruginosa. sparse growth. sensitivities performed on culture # 316-4888h on 11:34 am mrsa screen source: nasal swab. **final report ** mrsa screen (final ): positive for methicillin resistant staph aureus general urine information type color appear sp 14:47 yellow clear 1.016 source: kidney dipstick urinalysis blood nitrite protein glucose ketone bilirub urobiln ph leuks 14:47 neg neg neg neg neg neg neg 5.0 neg source: kidney 12:13 pm blood culture source: line-right subclavian. **final report ** blood culture, routine (final ): no growth. brief hospital course: patient is a 67m with a presented for an elective cholecystectomy. post operatively on day 2, he started developing a decline in mental status and worsening respiratory status/hypoxia. he was given lasix and diuresed ~800 with some improvement in mental status but still had persistent desaturations with copious secretions. he was transfered to the sicu for management of secretions, pulmonary toilet and diuresis. at baseline patient with altered mental status. he was receiving adequate pain control with oxycodone. he was hemodynamically unstable and was placed on pressors. he responded to fluid bolus and was weaned off of pressors. he has a history of chf and was given lasix 20mg for diuresis. he was started on his home diltiazem and lisinopril. patient was on face mask in the icu and weaned down to o2 nasal cannula. he was continued on a pulmonary toilet with is. he was found to have pseudomonas in sputum cx and started cipro for additional coverage. on pod #6, he was transferred to the floor. he continued with pulmonary toilet and lasix for diuresis. a dobhoff feeding tube was placed for tube feedings because there was a concern for aspiration. he was evaluated by speech and swallow and found to aspirate, because of this, he was maintained npo. tube feedings were not started because the patient discontinued the feeding tube and would not allow placment of another. he again was evaluated by speech and swallow and again made npo. recommendations for a peg were addressed with the patient, but he refused this. during this time, he did have periods of confusion and somulence and his anti-psychotics and narcotics were discontinued. as his mental status improved, he was gradully introduced to pureed foods under supervision which he did tolerate. his foley catheter was discontinued on pod # 8 and he has been voiding without difficulty. his vital signs are stable and he is afebrile he continues on his ciprofloxacin for pneumonia and required encouragement to cough. he has been out of bed and ambulates with assistance to a chair. he continues to have occasional bouts of confusion, but has been cooperative. he is preparing for discharge to an extended care facility. he will follow-up with the acute care service in 2 weeks. medications on admission: lisinopril 20', loratatidine 10', diltiazem 120''', trazadone 50 qhs, zoloft 50', lantus 20 qhs, senna 8.6 2 tabs qhs, bisacodyl 10 suppository prn', milk of mag prn' discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) cc injection tid (3 times a day). 2. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob. 3. sodium chloride 3 % solution for nebulization sig: 3-5 mls inhalation q4h (every 4 hours) as needed for secretions. 4. lisinopril 20 mg tablet sig: one (1) tablet po once a day: hold for systolic blood pressure <110, hr <60. 5. loratadine 10 mg tablet sig: one (1) tablet po once a day. 6. senna 8.6 mg tablet sig: two (2) tablet po once a day: hold for diarrhea. 7. lantus 100 unit/ml solution sig: twenty (20) units subcutaneous at bedtime: monitor blood sugar prior to meals and bedtime. 8. trazadone sig: fifty (50) mg at bedtime. 9. zoloft 50 mg tablet sig: one (1) tablet po once a day. 10. ducolax sig: one (1) suppository at bedtime: as needed for constipation. 11. diltiazem hcl 120 mg tablet sig: one (1) tablet po three times a day: hold for blood pressure <110, hr <60. 12. ciprofloxacin 500 mg tablet sig: one (1) tablet po twice a day for 6 days: 2 week course, started on . 13. insulin lispro 100 unit/ml solution sig: 0-6 units subcutaneous asdir (as directed): prior to meals, as per scale. 14. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day). discharge disposition: extended care facility: manor extended care facility - discharge diagnosis: cholecystitis pneumonia dysphagia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital for removal of your gallbladder. you did develop pneumonia during your stay and have been on antibiotics. you are now preparing for discharge to an extended care facility with the following instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: please follow up with the acute care service in 2 weeks. you can schedule this appointment by calling # procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arterial catheterization cholecystectomy diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified pneumonia due to pseudomonas long-term (current) use of insulin chronic diastolic heart failure laparoscopic surgical procedure converted to open procedure acute and chronic cholecystitis other dysphagia 

Answer: The patient is high likely exposed to