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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory failure major surgical or invasive procedure: mechanical ventilation history of present illness: 74m history of avr, pacer, afib, iddm s/p appy c/b intraperitoneal bleed, mrsa(was on linezolid) pna c/b loculated right parapneumonic effusion requiring chest tube, thoracostomy and vats decortication procedure, vap, tbm and eventually trach/peg. he has been at rehab since . trach removed last week. he was feeling better until yesterday when he started getting more sob and required trach replacement and started on vancomycin. on day of presentation, he got agitated and pulled out trach at 3am witnseed by rt, went unresponsive and diaphoretic. a respiratory code was called, trach replaced and ambu bagged until arousable. at ed, his initial vs were t:99 p:56 bp:135/44; r24: 98% on tm. ekg is v paced. cxr show lll pna. he was given ceftazidime in the ed. he was agitated, given ativan and restrained. surgery was made aware of trach. patient is somnolent on admission and not able to provide any additional history. past medical history: past medical history: 1. hypertension. 2. placement of ddd pacemaker secondary to av block 3. chf ef 50% last echo 4. avr 5. h/o aflutter 6. aortic root aneurysm s/p repair 7. s/p appy c/b by above social history: the patient quit smoking 40 years ago. married. originally from . family history: non-contributory physical exam: t98.1 p67(aflutter) bp154/81 r21 ac 500 x10(16)/5/1.0 gen- somnolent, only grimace to deep sternal rub heent- anicteric, pinpoint pupils, slightly reactive to light, dry mucus membrane, trach site clean cv- regular, mechanical valve click observed, no rubs/murmur resp- clear bilaterally, no wheezes abdomen- soft, nontender, nondistended, normoactive bowel sounds neuro- somnolent ext- 2+ pedal edema. pertinent results: labs on admission: 06:30am blood wbc-12.7* rbc-2.94* hgb-9.3* hct-29.9* mcv-102* mch-31.5 mchc-30.9* rdw-24.5* plt ct-405 06:30am blood neuts-83* bands-1 lymphs-10* monos-6 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:30am blood hypochr-2+ anisocy-2+ poiklo-normal macrocy-2+ microcy-normal polychr-occasional stipple-occasional acantho-occasional 05:11am blood pt-23.5* ptt-40.2* inr(pt)-2.3* 06:30am blood glucose-119* urean-41* creat-1.0 na-139 k-5.0 cl-102 hco3-31 angap-11 06:30am blood ctropnt-0.01 06:30am blood ck(cpk)-29* 06:30am blood calcium-8.5 phos-4.0 mg-2.1 03:30am blood caltibc-168* vitb12-595 folate-greater th ferritn-140 trf-129* 06:45am blood lactate-2.1* labs on discharge: 03:30am blood wbc-7.3 rbc-2.73* hgb-8.6* hct-28.2* mcv-103* mch-31.4 mchc-30.4* rdw-24.6* plt ct-368 03:30am blood glucose-124* urean-26* creat-0.7 na-141 k-3.9 cl-109* hco3-27 angap-9 03:30am blood calcium-8.1* phos-2.9 mg-2.1 iron-27* radiology: cxr ap -percutaneous gastrostomy tube tip overlies the left mid abdomen just below the left twelve posterior rib. without contrast injection, it is not possible to determine whether this is within the bowel or extraluminal. nonobstructive bowel gas pattern is visualized. diffuse skeletal abnormalities related to previous vertebroplasty procedures are noted. cxr ap - tracheostomy tube is now positioned vertically in the trachea. bibasilar consolidation which developed between and has increased. on the left this is quite likely pneumonia, on the right pneumonia and/or atelectasis. small right pleural effusion is stable. no pneumomediastinum or pneumothorax. transvenous right atrial and right ventricular pacer leads are in positions essentially unchanged since , including an atrial line which loops close to the tricuspid valve before returning to position likely in the right atrium. g/gj tube check port-- impression: placement of peg tube with tip placement confirmed by injection of gastrografin by resident in icu. cxr-tracheostomy tube and permanent pacemaker remain in standard position. bilateral perihilar and basilar lung opacities are again demonstrated with very minimal improved aeration on the left manifested by improved visualization of the left hemidiaphragm and slight worsening on the right. bilateral pleural effusions, right greater than left, are unchanged. microbiology: 3:14 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (preliminary): sparse growth oropharyngeal flora. gram negative rod(s). rare growth. bcx x 2-ngtd ucx-no growth legionella ab negative **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs. 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. trimethoprim/sulfa sensitivity testing performed by . please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- s vancomycin------------ <=1 s brief hospital course: impression: pt is a 74 male hx avr, pacer, afib, iddm s/p appy c/b intraperitoneal bleed, mrsa(was on linezolid) pna/vap c/b loculated right parapneumonic effusion requiring chest tube, thoracostomy and vats decortication, tbm, now chronically trach/peg, into ed after self decannulated in nursing home 1. respiratory distress: -likely lll pna seen on cxr, lactate 2.1, and leukocytosis on admission. he was initially placed on vancomycin (history of mrsa pna), levaquin, and flagyl and the flagyl was d/cd. on discharge day, we changed his antibiotics to doxycycline and flagyl and d/cd the levaquin as qtc ~510 and this would provide adequate coverage for aspiration and communication acquired pneumonia. -in terms of his trach, initially it was at a 45 degree angle on cxr. subsequent repositioning of it on repeat cxr it is in the proper location. -the patient was ventilated on ac which was changed to pressure support. he should continue on this with a wean when able. -blood culture, sputum cultures do not show any growth. 2. wound infection- wound infection from right upper back is a hematoma from vats/decortication surgery. he had a hematoma drained by thoracic surgery on . wound culture is growing mrsa. he will continue vancomycin for a 14 day course. gets wound packing to it and has follow up with thoracic surgery in 1.5 weks. 3. aortic valve replacement- valve. was on lovenox and coumadin when came in and lovenox d/cd as inr was >2 (goal ). will need to adjust coumadin accordingly and monitor inr closely. 4. diabetes mellitus- maintained on insulin sliding scale while pt was here. 5. mental status/agitation- initially unresponsive when he came here though quickly improved. at night often became agitated. he was on haldol iv bid. seroquel was tried as well. we continued mirtazapine qhs. 6. atrial flutter- continued pt's metoprolol, aspirin and amiodarone. we spoke to pt's cardiologist, dr. . the plan is to keep patient on amiodarone for possible cardioversion in the future. in conjunction with cardiologist, decreased amiodarone to 200 mg qday. 7. chf- initially held lasix but then continued it per outpatient dose. 8. f/e/n- tube feeds. nutrition made recommendations. 9. code- full 10. ppx- coumadin, ppi 11. access-picc medications on admission: amiodarone 400 mg daily mirtazapine 15mg qhs mvi aspirin 81 donepezil 5mg lovenox oxycodone prn metoprolol 50 mg omeprazole 20mg qd vancomycin 1g q12 haloperidol 5 mg prn warfarin 3 mg qhs(discharged on that, not on current med list from nh) furosemide 20mg po qday discharge medications: 1. amiodarone 200 mg tablet : one (1) tablet po daily (daily). 2. mirtazapine 15 mg tablet : one (1) tablet po hs (at bedtime). 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. donepezil 5 mg tablet : one (1) tablet po hs (at bedtime). 5. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 6. vancomycin in dextrose 1 g/200 ml piggyback : one (1) intravenous q 12h (every 12 hours): continue until . 7. doxycycline hyclate 100 mg recon soln : one (1) intravenous twice a day for 7 days: until . 8. flagyl 500 mg tablet : one (1) tablet po three times a day for 7 days: until . 9. furosemide 20 mg tablet : one (1) tablet po once a day. 10. oxycodone 5 mg tablet : two (2) tablet po q6h (every 6 hours) as needed. 11. lansoprazole 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 12. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q4-6h (every 4 to 6 hours) as needed. 13. warfarin 1 mg tablet : three (3) tablet po hs (at bedtime). 14. insulin regular human 100 unit/ml solution : per insulin sliding scale injection asdir (as directed). 15. haldol per outpatient dose. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: respiratory failure pneumonia secondary diagnosis: atrial flutter mechanical valve with anticoagulation congestive heart failure multiple myeloma discharge condition: stable. patient is on ventilatory support and issues are being treated. discharge instructions: follow up on your appointemnts below. ventilatory settings on discharge: cpap+ps 10/5 fio2 50%. antibiotics- continue antibiotics for a total of two weeks (dates on medication list) followup instructions: provider: , md phone: date/time: 10:00 provider: clinic phone: date/time: 10:30 provider: , md phone: date/time: 11:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified other postoperative infection unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation infection with microorganisms resistant to penicillins atrial flutter heart valve replaced by other means acute and chronic respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin multiple myeloma, without mention of having achieved remission cardiac pacemaker in situ tracheostomy status 

Answer: The patient is high likely exposed to