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: history of present illness: patient is a 28-year-old male with t12 paraplegia and decubitus ulcers, chronic renal insufficiency, who presented with fever and hypotension. patient is status post recent admission to plastics service from to for treatment of stage iv right greater trochanter necrotizing ulcer and underwent operative procedure including closure to that area. he was also noted to have enterobacter urinary tract infection. patient's wound cultures grew enterococcus and presumptive mrsa. he was treated with linezolid, cefepime, and flagyl, and ultimately discharged on linezolid alone. per the discharge summary, the patient was taking linezolid, however, the patient does not report taking this at home. the patient reports feeling somewhat fatigued three days prior to admission. on the day prior to admission, he noted fever to 104 while at home. he felt slightly nauseous, did not vomit, and denies abdominal pain. he had loose stools for one day, which is unchanged from his baseline. he denied shortness of breath or cough. denied chest pain. denied headache or mental status changes. he denied dysuria. he notes that he has not been straight cathing 4x a day as directed. in the emergency room, the patient was febrile to 103.7, and initially noted to be tachycardic to the 100's with a blood pressure of 128/60. large decubitus ulcers were also noted and a white blood cell count of 12,000 was noted. a chest x-ray and urinalysis were negative. hematocrit was found to be 18. he was transfused 2 units of packed red blood cells. early in the morning, the patient was noted to have an oral temperature of 93.5 with a blood pressure of 64/32 and heart rate in the 70's. he was given 4 liters of normal saline, and his blood pressure improved into the 90's. he had appropriate urine output to this. the patient was also given linezolid at that time. the patient was then transferred to the micu for further treatment of his presumed sepsis. past medical history: 1. t12 paraplegia from mva in . 2. decubitus ulcers stage iv right greater trochanter, stage ii right ischial, stage iii left greater trochanter, stage ii left heel, stage iv coccyx. 3. status post flap closure bilaterally two trochanteric ulcers. 4. recurrent urinary tract infections. 5. chronic renal insufficiency secondary to obstructive uropathy, baseline creatinine of 2.7. 6. seizure disorder with a normal electroencephalogram in . 7. question of clostridium difficile colitis. 8. mrsa. allergies: 1. dilantin, seizing. 2. vancomycin and levofloxacin which gives severe hives. 3. bactrim hives and throat culture. medications on admission: 1. xanax one tid. 2. oxycontin 40 . 3. percocet 1-2 tablets po q4-6h prn. 4. depakote 1,000 . social history: the patient lives in with his mother. denies tobacco. denies alcohol. denies iv drug use. denies hiv risk factors. physical examination: on physical exam, the patient was a thin white male sitting upright in bed in no acute distress. alert and oriented. temperature max 103.7, t current 93.4, pulse of 80, blood pressure 105/63, respirations 16. heent: normocephalic, atraumatic. pupils are equal, round, and reactive to light. extraocular movements are intact. oropharynx was significant for some white patches on the tongue. neck was supple. neck veins were flat. lungs were clear to auscultation and percussion. cardiovascular examination: regular, rate, and rhythm, normal s1, s2, no murmurs, rubs, or gallops. abdominal examination: bowel sounds present, nondistended, and nontender, soft and flat. extremities: warm, wasting noted in the lower extremities, flaccid lower extremities. decubitus ulcers included right and left ulcers over the greater trochanters, ulcer on the coccyx, and also bilateral heel ulcers. neurologic: the patient was alert and oriented times three. cranial nerves ii through xii were intact. absent sensation in the lower extremities. speech was fluent. laboratories on admission: significant for a white count of 12.2, hematocrit 18.4, with 2 units, this increased to 22.4. platelets of 404. chem-7 was significant for a creatinine of 3.8. urinalysis was negative, 0-2 white blood cells, less than 1 red blood cell, and no ketones. blood cultures and urine cultures were drawn on admission. on admission to the micu, the patient was supported with fluids as needed. patient was also started on linezolid and meropenem empirically for presumed sepsis. patient remained stable overnight and on , the patient was transferred from the micu to the medicine firm. summary of hospital course: 1. fever and hypotension, presumed sepsis. although initially the source of infection was not known, patient was started empirically on meropenem and linezolid for presumed sepsis secondary to osteomyelitis. although the patient originally declined mri to evaluate for osteomyelitis on , the patient underwent a mri to evaluate which showed right ischium and right greater trochanter osteomyelitis and also a right greater trochanteric fracture. in addition, there was evidence for a left greater trochanter osteomyelitis, this is evidenced by bone marrow edema as well as enhancement. the patient's wounds were cultured and these revealed coagulase-positive staphylococcus aureus, three colonies. sensitivities on these later revealed that one colony was linezolid resistant mrsa. upon this finding, the patient was switched from linezolid to synercid. in addition, the patient's wound revealed gram-negative rods pansensitive to klebsiella and additionally rare yeast. prior to his change to synercid, the patient did have one spiking temperature on to 101.3. the patient was again cultured. all cultures remained negative on this patient. given the patient's history of recurrent urinary tract infections, an additional source of infection was considered, however, urine cultures were also negative for this patient. the patient remained stable, afebrile with blood pressures in the 110s/60s to the time of transfer to the plastic service on . patient will continue on his antibiotics, meropenem and synercid. 2. chronic renal insufficiency: patient was admitted with a creatinine of 3.8. patient was hydrated and this improved throughout his hospital course, and on the time of transfer to the plastic service, the patient's creatinine was stable at 2.6. this was much improved for this patient and well within the patient's baseline. mri which had been performed had suggested hydronephrosis as a consequence of this on , a renal ultrasound was performed to evaluate the patient's kidneys. renal ultrasound showed mild right hydronephrosis unchanged from prior. in addition to this, there was moderate to severe left hydronephrosis, possibly increased from prior. dr. , the patient's nephrologist, was aware of these results. given the patient's improvement in renal function and the chronic nature of his hydronephrosis, this was not deemed to be an acute inpatient issue. the patient will follow up with dr. further for complete followup of his bilateral hydronephrosis. 3. decubitus ulcers: the ulcers were evaluated and followed by the plastics service. she will need further debridement of these wounds, which will be followed up upon his further hospital course on transfer to the plastics service. 4. osteomyelitis: patient with mri confirmed osteomyelitis, also requiring surgical debridement. the plastics and orthopedic surgery teams are coordinating for a surgical date. by request for surgical planning and further evaluation of the osteomyelitis, in addition to the mri on , a ct scan of the patient's pelvis was obtained on as well as plain films. this again, will be managed further as his hospital course continues on the plastics service. 5. seizures: the patient had a history of seizures last in . the patient was admitted on depakote for seizure prophylaxis, however, valproic acid levels were checked while in house, and these remained consistently low. a trial of iv valproic acid was attempted, however, the valproic acid levels remained low. this is possibly due to a medication which is inducing the t450 system and altering the clearance of valproic acid. as a result, the neurology service was consulted due to his need for change in seizure prophylaxis and also a completed workup given the fact the patient had missed outpatient appointments with neurology due to his admission. they suggested the patient start on keppra. renal dosing for this was considered, and the patient remains on a dose of 750 mg of keppra for seizure prophylaxis. the patient tolerated this change well. there have been no seizures while on service. the neurology team evaluated the patient, and a mri of the patient's head was obtained on . there were no focal abnormalities. the neurologic team signed off on this patient, and the patient should follow up in clinic with dr. or dr. . 6. right shoulder pain: the patient complained of pain in his right shoulder after the ct scan of his pelvis, when he said during movement for this scan, he injured his right shoulder. the patient had an old right shoulder injury as well. patient's shoulder was somewhat swollen, and he had decreased range of motion secondary to pain. on , a shoulder mri was obtained which revealed no bony abnormalities, no soft tissue or ligamentous injury. the patient was given ultram as an additional pain medication in an effort to make him more comfortable. the patient can followup for this right shoulder pain with orthopedics during this hospital course. 7. chronic pain: patient with multiple decubitus ulcers requiring outpatient pain medications. the patient was continued on his oxycodone and also oxycodone acetaminophen prn. the patient was not utilizing any maximum doses of these medications while in-house. 8. anemia: the patient was admitted with a hematocrit of 18. he was transfused 2 units of packed red blood cells. patient's hematocrit increased from this and remains stable at a hematocrit of 28 while on the medicine service. patient's stool was guaiacked, and the patient was guaiac negative. there was no evidence for blood loss anemia was presumed secondary to anemia of chronic disease. the patient was started on epogen shots for further management of his anemia. 9. fen: the patient was taking good po while in house. he occasionally required repletion of magnesium and required phosphate binders. the patient's potassium rose to 5.3 on occasion while in-house. this was deemed to be due to excessive drinking of gatorade, and the patient was encouraged to minimize this intake. 10. psychiatric: patient is followed by social work for psychiatric issues surrounding his diagnosis and paraplegia. the patient declined any further intervention by psychology at this time. this is a summary of hospital course up until when the patient was transferred to the plastic service for further surgical planning for debridement of his wounds and underlying osteomyelitis. on transfer to the plastic service, the patient was stable. he was afebrile and had not been hypotensive for well over a week. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube graft of muscle or fascia advancement of pedicle graft advancement of pedicle graft excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn other partial ostectomy, other bones injection or infusion of oxazolidinone class of antibiotics diagnoses: acute posthemorrhagic anemia other convulsions hydronephrosis paraplegia late effect of spinal cord injury acute osteomyelitis, multiple sites abscess of anal and rectal regions 

Answer: The patient is high likely exposed to