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: service: micu-acove history of present illness: the patient is a 58 year old woman with multiple medical problems including congestive heart failure, chronic obstructive pulmonary disease, sleep apnea, cor pulmonale with right heart failure, obesity, and end-stage renal disease requiring hemodialysis. the patient has had recent admissions at the in and of this year, most notably for a line infection. two days prior to admission, the patient's son noted increasing somnolence. the patient underwent hemodialysis on , and was subsequently noted to be more somnolent by her . as such, she was referred back to the for further management. past medical history: 1. morbid obesity. 2. congestive heart failure; last echocardiogram , with marked right ventricular dilation; left ventricular function 58 to 55%, four plus tricuspid regurgitation with severe pulmonary hypertension. 3. chronic obstructive pulmonary disease. 4. obstructive sleep apnea; the patient does not use bipap at home and has known right heart failure and cor pulmonale. 5. hypertension. 6. history of atrial flutter not currently anti-coagulated. 7. chronic renal insufficiency on hemodialysis. 8. peripheral vascular disease. 9. multiple urinary tract infection, most recent being a klebsiella and e. coli in of this year. medications at home: 1. protonix 40 mg p.o. q. day. 2. amiodarone 200 mg p.o. q. day. 3. neurontin 300 mg p.o. q. day. 4. nephrocaps 1 tablet p.o. q. day. 5. vioxx 12.5 mg p.o. q. day p.r.n. 6. tums 500 mg p.o. three times a day with meals. 7. prozac 20 mg p.o. q. day. 8. remeron 7.5 mg p.o. q. h.s. 9. albuterol mdi. 10. atrovent mdi. 11. flovent 44 micrograms two puffs twice a day. 12. the patient also uses home o2. allergies: the patient has a reported allergy to demerol, unknown effect. the patient is also allergic to nuts resulting in anaphylaxis. social history: the patient has a 70 pack year history of tobacco use. she also notes ethanol abuse. she is married; she is bed and wheelchair bound secondary to deconditioning. she has a and has family members assist her activities of daily living. the patient has refused rehabilitation in the past. physical examination: on admission, temperature 99.4 f., pulse of 86; blood pressure 101/40; respiratory rate of 19 with an oxygen saturation of 93%, with mechanical ventilation fio2, 30%, pressure support 5, peep of 5. the patient was somnolent but arousable to noxious stimuli. her heent examination was unremarkable with pupils equal, round and reactive to light. sclerae anicteric. extraocular movements are intact. mucous membranes dry without oral lesions. her neck was supple, obese. a right ij catheter was in place. it was difficult to assess jugular venous distention. carotids were two plus without bruits. her heart sounds were distant but regular in rate and rhythm without notable murmurs, rubs or gallops. normal s1 and s2. her lungs had bibasilar crackles, right greater than left. no wheezes were noted. her abdomen was obese, soft, with diffuse mild tenderness. her extremities had no cyanosis, clubbing or edema. she had a 2 cm by 3 cm ulceration on the right lateral aspect of her shin, with a question of purulent drainage. on neurologic examination, she was oriented to place only. reflexes were symmetric bilaterally. laboratory: on admission, white blood cell count 14.4, hematocrit 33.5, platelets 175, mcv of 102. sodium 138, potassium 4.1, chloride 101, bicarbonate 23, bun 19, creatinine 3.1, glucose 94. calcium of 9.0, phosphorus of 3.4, magnesium of 1.5, free calcium of 1.32. differential on the white blood cell count is as follows: 77% polys, 7 bands, 9 lymphs, 5 monos, 2 eosinophils. initial arterial blood gas is as follows: ph 7.19, pco2 of 69, po2 of 43. chest x-ray showed increased interstitial lung markings in the lower lung zones, hilar fullness, mild congestive heart failure, question of infiltrate. ekg was normal sinus rhythm at a rate of 65, borderline right axis deviation with right bundle branch block. mild st depression in the precordial leads. no significant changes from prior ekg of . summary of hospital course: in the emergency department, the patient was found to be afebrile and hypotensive with systolic blood pressure in the 70s. the patient was given fluid resuscitation and with 1.2 liters, subsequent chest x-ray showed mild congestive heart failure. her white blood cell count was noted to be elevated at 14.4 with a left shift. as such, she was started on antibiotics of broad-spectrum, including vancomycin, levofloxacin and flagyl. arterial blood gas was 7.19/69/43. the patient was started on dopamine after placement of a right ij catheter and transferred to the intensive care unit for further management. the patient was intubated for her progressively worsening acidosis with repeat arterial blood gas of 7.17, 68, 64. after intubation, the patient's next arterial blood gas was 7.22, 54, 102. cultures were taken including blood, sputum and of the wound. only colonizing organisms were noted from the right shin wound culture, including methicillin resistant staphylococcus aureus. given her previous history of resistant klebsiella and e. coli, the patient's antibiotic coverage was changed to meropenem for renal dosing and vancomycin. the patient was then continued on a ten day course of these antibiotics with good response. it was believed that the patient most likely suffered from a pneumonia and, on , the patient self-extubated. the patient subsequently developed stridor and was started on steroids and re-intubated. the patient continued to do well and, on , pressors were weaned off, and the patient was subsequently extubated and then transferred to the floor on , to complete her ten day course of antibiotic. the patient continued to convalesce well and on , was discharged to home without change in any of her prior medications. discharge diagnoses: 1. pneumonia. 2. sepsis. secondary diagnoses: congestive heart failure. chronic obstructive pulmonary disease. obstructive sleep apnea. morbid obesity. hypertension. peripheral vascular disease. end-stage renal disease on hemodialysis. atrial arrhythmia, currently in sinus rhythm. discharge medications: 1. amiodarone 200 mg p.o. q. day. 2. neurontin 300 mg p.o. q. day. 3. protonix 40 mg p.o. q. day. 4. tums 500 mg p.o. three times a day with meals. 5. nephrocaps one tablet p.o. q. day. 6. prozac 20 mg p.o. q. day. 7. remeron 7.5 mg p.o. q. h.s. 8. albuterol mdi. 9. atrovent mdi. 10. flovent 44 micrograms, two puffs three times a day. 11. vioxx 25 mg p.o. q. day p.r.n. discharge instructions: 1. the patient is to continue with her home o2 at approximately two liters. 2. she is scheduled for hemodialysis on monday, wednesday and friday. 3. she is to follow-up with her primary care physician, . , in approximately one week. dr. contact information is as follows: telephone number ; address , . , m.d. dictated by: medquist36 d: 10:59 t: 11:30 job#: cc: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis arterial catheterization diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial flutter acute respiratory failure diseases of tricuspid valve chronic pulmonary heart disease, unspecified 

Answer: The patient is high likely exposed to