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: inderal / bactrim / codeine / penicillins attending: chief complaint: epididymitis major surgical or invasive procedure: incision and drainage of fournier's gangrene history of present illness: the patient is a 75 year old male who was transferred from an outside hospital because of a suspected myocardial infarction on and possible need for cardiac catheterization. he was admitted to the cardiology service initially. his symproms actually began six days prior to admission with flu-like symptoms. then five days prior to admission, the patient began complaining of a painful lump in his left testicle. his symptoms gradually worsened, with increasing pain, erythema, and edema of his left testicle. in addition, he complained of difficulty urinating for two days prior to admission. he was admitted to an outside hospital four days prior to admission here, at which time a foley catheter was placed and he was started on iv levofloxacin and clindamycin (which was switched to levofloxacin and vancomycin the following day) for epididymitis diagnosed by ultrasound. the ultrasound also showed questionable air in the scrotum. the patient was seen by a urologist, dr. , as well as an infectious disease specialist. he denied any trauma to his scrotum. he has no significant urologic history. his prostate examination revealed a 20 to 25 gram nonfluctuent prostate. he is not diabetic and he is not immunocompromised. he reported that his pain has been improving on the antibiotics. however, on the night prior to admission he developed acute pulmonary edema, shortness of breath, hypotension and ekg changes suggestive of myocardial infarction (st elevation in leads v1- depression in v5-6). his peak troponin was 0.96. neo-synepherine was started upon admission because of hypotension, which was presumed to be secondary to sepsis. significant cardiac history includes a cabg in , hypertension, aortic stenosis, mitral regurgitation, high cholesterol, and congestive heart failure (ef of 40%). upon re-evaluation at this hospital, his ekg changes were thought to be secondary to demand ischemia, rather than a myocardial infarction. in addition, the patient was noted to be in acute renal failure, with a createnine of 1.8 on admission, likely due to prerenal causes. blood and urine cultures from the outside hospital were all negative. past medical history: as above. left femoral to popliteal bypass graft social history: none significant family history: none physical exam: general: no apparent distress heent: pupils equal, round and reactive to light, extraoccular muscles in tact neck: supple lungs: bibasilar crackles heart: irregularly irregular, 2/6 systolic ejection murmur diffusely gastrointestinal: soft, nontender, nondistended, bowel sounds positive genitourinary: enlarged (grapefruit sized) and edematous scrotum, can not palpate testicles due to edema, bilateral testicular tenderness (left greater than right), scrotal erythema extending faintly up the groin creases, penile edema, foley in place with dark yellow urine extremities: full range of motion and 5/5 strength in all four extremities neurologic: alert and oriented x 3, cranial nerves intact pertinent results: 01:17am blood wbc-18.2* rbc-3.82* hgb-12.5* hct-36.0* mcv-94 mch-32.6* mchc-34.6 rdw-14.0 plt ct-76* 03:48am blood wbc-14.0* rbc-4.01* hgb-12.5* hct-38.4* mcv-96 mch-31.2 mchc-32.6 rdw-14.6 plt ct-112* 08:02am blood wbc-14.0* rbc-3.32* hgb-10.5* hct-32.3* mcv-97 mch-31.6 mchc-32.5 rdw-14.6 plt ct-99* 01:20pm blood wbc-13.9* rbc-3.20* hgb-10.3* hct-30.2* mcv-95 mch-32.3* mchc-34.2 rdw-14.6 plt ct-99* 02:24am blood wbc-10.5 rbc-3.35* hgb-10.7* hct-31.9* mcv-95 mch-31.8 mchc-33.4 rdw-14.8 plt ct-121* 12:30pm blood hct-28.5* 01:53am blood wbc-9.3 rbc-2.91* hgb-9.5* hct-27.2* mcv-94 mch-32.7* mchc-35.0 rdw-14.7 plt ct-99* 02:30am blood wbc-8.8 rbc-2.90* hgb-9.2* hct-26.8* mcv-92 mch-31.6 mchc-34.3 rdw-14.6 plt ct-88* 01:29pm blood hct-26.1* plt ct-73* 11:43pm blood hct-28.8* 03:20am blood wbc-7.3 rbc-3.15* hgb-9.9* hct-29.1* mcv-92 mch-31.3 mchc-33.9 rdw-14.5 plt ct-53* 02:32pm blood wbc-8.8 rbc-3.07* hgb-9.6* hct-28.6* mcv-93 mch-31.4 mchc-33.7 rdw-14.7 plt ct-58* 02:39am blood wbc-7.7 rbc-2.81* hgb-9.0* hct-25.9* mcv-92 mch-31.9 mchc-34.5 rdw-14.6 plt ct-58* 02:15pm blood wbc-12.1*# rbc-3.18* hgb-10.1* hct-29.1* mcv-92 mch-31.8 mchc-34.6 rdw-14.5 plt ct-63* 02:38am blood wbc-7.6 rbc-3.16* hgb-10.0* hct-29.5* mcv-93 mch-31.6 mchc-33.9 rdw-14.6 plt ct-67* 03:46am blood wbc-7.4 rbc-3.22* hgb-10.1* hct-30.0* mcv-93 mch-31.3 mchc-33.6 rdw-14.7 plt ct-85* 01:15pm blood hct-25.7* 03:58pm blood hct-28.6* 02:34am blood wbc-8.4 rbc-3.20* hgb-10.0* hct-30.9* mcv-96 mch-31.2 mchc-32.4 rdw-14.5 plt ct-119* 02:03am blood wbc-5.6 rbc-3.00* hgb-9.4* hct-28.4* mcv-95 mch-31.3 mchc-33.1 rdw-14.5 plt ct-177 02:37am blood wbc-5.3 rbc-2.98* hgb-9.3* hct-28.2* mcv-95 mch-31.3 mchc-33.1 rdw-14.7 plt ct-183 02:14am blood wbc-5.2 rbc-3.20* hgb-10.0* hct-30.2* mcv-94 mch-31.1 mchc-33.0 rdw-15.5 plt ct-199 01:17am blood pt-14.4* ptt-28.2 inr(pt)-1.4 01:17am blood plt smr-very low plt ct-76* lplt-2+ 05:13pm blood pt-15.6* ptt-50.6* inr(pt)-1.7 02:30am blood ptt-53.2* 03:48am blood plt ct-112* lplt-2+ 08:02am blood pt-15.3* ptt-33.1 inr(pt)-1.6 08:02am blood plt ct-99* lplt-1+ 01:20pm blood pt-14.8* ptt-32.0 inr(pt)-1.5 02:34am blood plt ct-119* lplt-1+ 02:37am blood plt ct-183 02:14am blood plt smr-normal plt ct-199 lplt-1+ 01:17am blood glucose-94 urean-42* creat-1.8* na-140 k-4.4 cl-106 hco3-21* angap-17 05:13pm blood glucose-137* urean-55* creat-2.6* na-139 k-4.2 cl-107 hco3-20* angap-16 08:02am blood glucose-114* urean-52* creat-2.0* na-139 k-3.9 cl-111* hco3-19* angap-13 01:20pm blood glucose-156* urean-49* creat-1.9* na-138 k-4.2 cl-110* hco3-22 angap-10 02:24am blood glucose-92 urean-42* creat-1.7* na-138 k-4.8 cl-110* hco3-20* angap-13 12:30pm blood glucose-84 urean-35* creat-1.5* na-141 k-4.2 cl-112* hco3-22 angap-11 02:39am blood glucose-118* urean-17 creat-1.0 na-139 k-4.1 cl-106 hco3-29 angap-8 02:15pm blood glucose-115* urean-19 creat-1.0 na-137 k-3.7 cl-102 hco3-29 angap-10 02:38am blood glucose-111* urean-21* creat-1.0 na-137 k-4.2 cl-103 hco3-30 angap-8 10:16am blood glucose-113* urean-22* creat-1.0 na-138 k-4.1 cl-104 hco3-28 angap-10 03:58pm blood k-4.4 02:03am blood glucose-116* urean-21* creat-1.0 na-138 k-3.8 cl-110* hco3-23 angap-9 02:14am blood glucose-126* urean-25* creat-0.9 na-140 k-4.2 cl-112* hco3-23 angap-9 01:17am blood ck-mb-notdone ctropnt-0.15* 01:53am blood ck-mb-notdone ctropnt-0.22* 01:17am blood albumin-2.7* calcium-8.4 phos-3.0 mg-1.7 uricacd-6.4 02:24am blood albumin-2.2* calcium-8.4 phos-3.6 mg-2.3 uricacd-5.9 02:14am blood calcium-7.7* phos-3.2 mg-1.8 01:01am blood type- po2-38* pco2-43 ph-7.32* calhco3-23 base xs--3 01:36pm blood type-art po2-169* pco2-48* ph-7.29* calhco3-24 base xs--3 03:38am blood type-art po2-129* pco2-43 ph-7.42 calhco3-29 base xs-3 02:52am blood type-art temp-37.8 rates-/24 peep-5 fio2-40 po2-137* pco2-46* ph-7.46* calhco3-34* base xs-8 intubat-intubated 08:19pm blood type-art po2-114* pco2-40 ph-7.43 calhco3-27 base xs-2 04:14pm blood type-art po2-126* pco2-32* ph-7.47* calhco3-24 base xs-1 05:30pm blood type-art temp-36.9 rates-10/ tidal v-900 peep-5 fio2-40 po2-130* pco2-35 ph-7.48* calhco3-27 base xs-3 intubat-intubated brief hospital course: the patient was admitted to the cardiology service at on for presumed myocardial infarction on electrocardiogram, which was later attributed to demand ischemia due to sepsis. he was initially started on neo-synephrine for hypotension. he was continued on vancomycin and levofloxacin for his epididymitis. the urology team saw and evaluated the patient as a consult service under dr. . our suspicion of fournier's gangrene at that time was very low, considering his lack of risk factors and lack of significant groin erythema, however a ct scan of his abdomen and pelvis was ordered to rule out fournier's. that ct scan confirmed the diagnosis of fournier's gangrene on the morning of hospital day two (tracking of air around his left hemi scrotum tracking up the left spermatic cord. at that time, the patient was emergently rushed to the operating room for emergent surgical debridement by dr. and dr. , chief urology resident. during the operation, the patient had the majority of his left scrotum and all of his left testicle removed. he was then admitted to the trauma intensive care unit. he was sedated on propofol with fentanyl for pain. he was started on a levophed drip to maintain blood pressure. a central venous line was placed, as well as a swann ganz catheter. an oro-gastric tube was placed and put to gravity. his foley was continued from the operating room. dressing changes to his scrotum were scheduled for three times per day. on postoperative day two, his maximum temperature was 101.0. his levophed drip was weaned to a low level. tube feeds were started through his ng tube. on postoperative day three, the plastic surgery service began their evaluation of the patient for future closure of his wound. his propofol was discontinued. his levophed was discontinued. he vomited twice and his tube feeds were held for high residuals. he recieved one unit of red blood cells for a hematocrit under 30, and his hematocrit responded well. his acute renal appeared to have resolved, as his createnine dropped down to 1.0. on postoperative day four, his ventillator was weaned to pressure support, however he had some apneic spells. a hit panel was negative and his subcutaneous heparin was restarted. he had some bedside debridement by the urology team and his wound looked like it was healing well. he was transfused with another unit of red blood cells. the patient was noted to be roughly twenty liters positive and diuresis with a lasix drip was started as tolerated. on postoperative day seven, the patient required some propofol for sedation due to endotracheal tube and oro-gastric tube irritation. a sputum culture came back positive for mrsa sensative to vancomycin. his wound cultures were positive for mixed flora including bacteroides, provatella, and coagulase negative staphylococcus. a wound vac was placed by urology. on postoperative day eight, a post-pyloric feeding tube was placed by interventional radiology because the patient was not tolerating tube feeds via the oro-gastric tube. on postoperative day nine, dr. agreed to allow placement of a tracheostomy tube and a peg tube at a later date. the patient had been unable to tolerate a ventillator wean up to this point, most likely due to his fluid overload and his cardiac history. tube feeds were running at agoal of 90ml/ hour. on postoperative day ten, his flagyl and levofloxacin were discontinued. he was transfused one unit of blood for a hematocrit less than thirty. on postoperative day twelve, he recieved another unit of red blood cells. on pod 14, a #8 percutaneous trach was placed at the bedside. a perc peg was placed uner direct visualization, but the tube was pulled through the abdominal wall. the patient was subsequently taken to the or for an open gastrostomy tube which was placed without further complication. vancomycin was stopped on after a complete 14-day course. on , the wound was closed primarily at the bedside by the plastic surgery service. tf were restarted on and advanced as tolerated. a picc line was also placed on . propofol was d/c'd on . on , the patient spiked a temp to 102. cultures were drawn and the a-line tip sent for culture as well. tube feeds were held for high residuals, an ileus was found on imaginig. pt evaluation occured on . trach mask trials were started on and the vent weaned as tolerated, with the patient still requring vent assistance most of the day. vancomycin was restarted on for mrsa sputum; it will be continued for 7 days; the jp drain was removed on this day as well. tf were restarted on and brought to goal over the next day. the patient is now tolerating tf at goal with bowel movements. on , the patient was tolerating tf at goal, having bowel movements, tolerating trach mask trials daily, was working with pt, had good pain control with roxicet elixer, was alert and requring no sedation. he was subsequently transfered to rehab for physical therapy and vent weaning. medications on admission: lipitor 20', atenolol 25', asa 81', zestril 5', protonix 40' discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 6. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 8. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours) as needed. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. phenol-phenolate sodium 1.4 % mouthwash sig: one (1) spray mucous membrane q4h (every 4 hours) as needed. 11. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed. 15. morphine sulfate 1-2 mg iv q3-4h:prn prn breakthrough pain 16. metoclopramide 10 mg iv q6h 17. dolasetron mesylate 12.5 mg iv q8h:prn 18. vancomycin hcl 1000 mg iv q 12h 19. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 20. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 21. lorazepam 0.5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 22. midazolam hcl 0.5-1 mg iv q4h:prn anxiety discharge disposition: extended care facility: & rehab center - discharge diagnosis: fournier's gangrene discharge condition: stable discharge instructions: tube feeds: promote with fiber @ 90cc/hr md for: * fever * inability to tolerate tf * erythema/increased discharge from wound * uncontrolled pain followup instructions: abdominal staples to be removed on scrotal sutures to be removed 3 weeks after closure on vancomycin to be d/c'd procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy temporary tracheostomy biopsy of parathyroid gland excision or destruction of lesion or tissue of scrotum other gastrostomy unilateral orchiectomy diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status accidental puncture or laceration during a procedure, not elsewhere classified vascular disorders of male genital organs paralytic ileus other inflammatory disorders of male genital organs accidental cut, puncture, perforation or hemorrhage during other specified medical care 

Answer: The patient is high likely exposed to