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: penicillins attending: chief complaint: r iliac vein bleeding major surgical or invasive procedure: right iliac vein packing history of present illness: 77 year old female transferred from s/p right hip acetabular clean out and removal of infected hardware on (presumed to be seeded from septic shoulder) for evaluation of intraoperative bleeding. wound left open and packed and angiogram negative at osh. transferred emergently to where right iliac vein was packed x's 2. had ivc filter placed on in setting of afib and not able to anticoagulate d/t bleed. . while in the sicu the patient has had intermittent episodes of hypotension supported by fluids, blood, and neosynephrine (), felt to be d/t blood loss vs. sepsis. also with repeated episodes of a fib, the first treated with diltiazem gtt, the second amiodarone load, and the third repeat amiodarone load. of note, the patient first became febrile to 101.5 on and ppx cefazolin was changed to vanc/levo/flagyl and picc and swan pulled. she grew serratia and enterobacter in sputum and blood cultures from . subsequent osh records were available showing mssa in wound (? bld) and vancomycin was changed to ancef. patient self extubated on and was immediately reintubated but then electively extubated on . was doing fairly well until the patient developed sustained vt times 2 last night, the first of which she spontaneously converted out of and the second of which required shock, intubation, and pressors. since then the patient has remained hypotensive with sbp 70-90's and bradycardic with hr in 50's. . currently the patient is intubated and sedated and unable to answer ros questions. past medical history: hyperlipidemia chf (ef 55%) gout anemia afib s/p cardioversion cardiomyopathy l hip fracture asthma social history: noncontributory family history: noncontributory physical exam: vitals: 98/57 (74), range 78-110/40-60), 58 (53-110), 100% vent: 420/16/0.6/10 --> 7.48/35/113 i/o's: 5l/450 out, los 7l pos heent: head symmetric and atraumatic, perrl, anicteric sclera neck: lij in place, cardiac: bradycardic, regular, nl s1 and s2, iii/vi sem at lusb lungs: diffuse rhonchi anteriorly, no wheeze abd: soft, obese, ntnd, nabs, no hsm, no rebound or guarding ext: cold, purplish pads of toes on right and left, 3+ pitting edema to hips, ue with diffuse anasarce neuro: sedated, intubated, able to move all ext pertinent results: 10:12pm type-art po2-150* pco2-44 ph-7.39 total co2-28 base xs-1 10:12pm glucose-122* lactate-0.8 10:12pm freeca-1.20 09:46pm type-art po2-367* pco2-41 ph-7.42 total co2-28 base xs-2 09:15pm glucose-129* urea n-11 creat-0.5# sodium-131* potassium-4.0 chloride-102 total co2-24 anion gap-9 09:15pm calcium-8.0* phosphate-3.1 magnesium-1.6 09:15pm wbc-15.6* rbc-3.23* hgb-9.3* hct-27.4* mcv-85 mch-28.8 mchc-34.0 rdw-17.6* 09:15pm plt count-244 09:15pm pt-13.6* ptt-31.5 inr(pt)-1.2* 08:01pm type- po2-55* pco2-50* ph-7.34* total co2-28 base xs-0 comments-central ve 08:01pm glucose-114* lactate-1.5 na+-128* k+-4.1 cl--104 08:01pm hgb-9.8* calchct-29 o2 sat-86 08:01pm freeca-1.09* 08:01pm wbc-12.5*# rbc-3.26* hgb-9.7*# hct-27.2*# mcv-84# mch-29.8# mchc-35.6* rdw-17.3* 08:01pm plt count-233 08:01pm pt-13.6* ptt-31.1 inr(pt)-1.2* . cxr : large pneumoperitoneum persists, smaller since 6:31 p.m. on . the tip of an enterostomy or gastrostomy tube projects over the left paramedian abdomen and appears to cannulate either a loop of bowel or a length of tubing, which is directed superiorly projecting over a collection of air above the diaphragm presumably in the thoracic portion of a gastric hiatus hernia. as i discussed with dr. , i am unfamiliar with any such appliance, and it is important to review these radiographs with the surgical team in light of their description of patient's abdominal procedure yesterday. . moderately severe pulmonary edema has improved slightly since accompanied by persistent small-to-moderate bilateral pleural effusion and mild cardiomegaly. there is no pneumothorax. tracheostomy tube is in standard placement. right internal jugular line tip projects over the upper right atrium. . note is made of the comminuted healing fracture of the right upper humerus. a caval umbrella filter projects over the inferior vena cava, close to the level of the renal veins. . ct torso : impression: 1. large amount of free intraperitoneal air. 2. gastrostomy tube is seen adjacent to the anterior wall of the stomach. injection of contrast material showed no leak. there is a discrepancy in gastric wall thickness covering the gastrostomy tube retainer compared to the thickness of the gastric wall elsewhere. while this is most likely located within the stomach, with thinning of the anterior aspect of the gastric wall due to tethering by the gastrostomy tube, location of the peg tube retainer within the gastric wall cannot be completely excluded. consultation with the surgery service who placed the tube should be performed prior to using the tube for tube feeds. 3. large bilateral pleural effusions. right effusion appears simple. the left effusion may be loculated given posterior tethering of the left lung. no frank enhancing septations are identified. 4. small amount of pneumomediastinum. 5. tracheostomy tube cuff appears slightly hyperinflated. 6. patchy areas of ground-glass opacity in aerated portions of both lungs with superimposed more confluent areas of opacity. findings could be due to asymmetrical pulmonary edema or superimposed infection. 7. bone destruction and fluid collection in right acetabulum/proximal right femur consistent with known hardware infection. post-traumatic changes in the right shoulder. l2 compression deformity, as described on prior mri. . mri brain : impression: limited due to significant amounts of patient motion artifact. the internal carotid arteries as well as the basilar artery appear patent. there is some flow signal present also within the middle cerebral, anterior, and posterior cerebral arteries. . tte : conclusions: 1. the left atrium is mildly dilated. the left atrium is elongated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is hard to assess given the limited views but susptect it is mildly decreasedl (lvef 45-55%). 3.right ventricular chamber size is normal. right ventricular systolic function is hard t oassess given the limited views but suspect normal function. 4.the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2) mild to moderate (+) aortic regurgitation is seen. 5.the mitral valve leaflets are moderately thickened. there is severe thickening of the mitral valve chordae. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. 6.there is an anterior space which most likely represents a fat pad. . sputum culture : gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. heavy 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. 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 vancomycin------------ <=1 s . blood culture and sputum culture : sensitivities: mic expressed in mcg/ml _________________________________________________________ serratia marcescens | enterobacter species | | cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ 2 s <=1 s imipenem-------------- s <=1 s levofloxacin----------<=0.25 s <=0.25 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s tobramycin------------ 8 i <=1 s brief hospital course: briefly, this is a 77 year old female with chf, afib, anemia, s/p hip fracture, seeding of hardware from septic shoulder s/p removal, who was transferred here for concern of intraoperative bleeding. she was initially admitted to the vascular service and taken to the or where bleeding of the r iliac artery was controlled with packing. she was taken to the or again the following day, , with exploration of right hip wound, removal of surgical packs, irrigation and closure of wound. subsequent hospital course while on vascular surgery was c/b difficult to control afib, vt requiring shock, hypotension, sepsis, and chf. she was transferred to the micu at this time. the following is her micu course: . # respiratory failure: the pt was initially intubated on s/p or due to hypoxia and respiratory failure. she was extubated on but again reintubated on due to vt arrest. she remained reintubated, and the reason for her failure to wean was felt to be multifactorial. initially the pt had pna which was treated with a 14 day course of vancomycin. she also had pulmonary edema and large bilateral pleural effusions felt to be chf-related. in addition, the pt was deemed to have icu myopathy based on nif of -5. the pt was aggressively diuresed because at one point she was 15 l positive. at the time of discharge, she was 3 l negative. at times during diuresis with lasix, she became hypotensive with sbp in 70s, requiring levophed to help with further diuresis. she continued to require ventilator support due to pleural effusions and muscular weakness (icu myopathy). she is on vancomycin currently for a 2 week course (start date ). her vanc level was elevated at 25 prior to discharge, so her random vanc level should be rechecked on . if her level is still >15, then her vancomycin 750 mg q 24 hr dosing will need to be adjusted. the pt was also treated with 1 week of meropenem whichw as discontinued at the time of discharge due to no gram negative growth in any culture. the pt had trach placed on . continue diuresis as able. . # id: the pt was hypotensive on transfer, felt to be due to sepsis in the setting of fever, wbc of 20, and enterobacter and serratia in her blood culutres from . she was treated with 2 weeks of vancomycin and meropenem at that time. her blood pressures remained borderline and she intermittently required levophed and 250 cc iv fluid boluses while being diuresed. on , the pt spiked a temp and again had an increased wbc and was restarted on vanc/meropenem for presumed vap and possible sepsis (had increased resp. secretions). second vanc/meropenem course is as per above. stim was wnl. . #rhythm: the pt remained in afib through most of her course, with the exception of sustained vt upon transfer to the micu. as per above, the pt required shock and 2 amio boluses. she remains on amiodarone and coumadin. her coumadin was restarted after trach, so inr will need to be monitored. her metoprolol had been stopped due to hypotension. . #chf: the pt had an ef of 45%, repeat tte showed ef 35%, and then repeat tte showed ef again of 45%. the pt was started on digoxin for her chf. she was also diuresed with iv lasix as per above until she was overall negative in her fluid balance. she was started on po lasix 10 mg prior to discharge. she was also started on low dose metoprolol. . #weakness: the pt was deemed to have icu myopathy by the neurology service. mri/mra of the brain was a poor study but did not reveal etiology of the weakness. c spine mri also did not reveal any etiology of the weakness. her weakness seems to be more proximal in nature, hence explaining the initial concern for "man in " syndrome. however, as per above, mri of the head did not validate this concern. the pt will need rehab for strengthening. . #fen: peg was placed on by general surgery. initial radiology reads were concerning for peg placement. pneumoperitoneum on xray reads is expected s/p peg placement. surgery felt the peg was in proper position without complication (after ct of the abdomen was performed), so tube feeds were initiated in the pt without difficulty. . # code: dnr--discussed with family . # comm: sister , pcp . two daughters (pts niece - and ) are hcp's. lives in the area, lives in md. . medications on admission: -hydromorphone 0.5-2 mg iv q2-4h:prn -insulin sc (per insulin flowsheet) -ipratropium bromide mdi 4 puff ih q4h on vent -levothyroxine sodium 75 mcg po daily -acetaminophen 325-650 mg po q4-6h:prn t>101.5 -lorazepam 0.5-1 mg iv q4h:prn -amiodarone hcl 200 mg po daily -magnesium sulfate 2 gm / 100 ml ns iv prn mag <2.0 -atorvastatin 20 mg po daily -miconazole powder 2% 1 appl tp -bisacodyl 10 mg po/pr daily:prn -miconazole nitrate vaginal 1 appl vg hs duration: 7 days -calcium gluconate 2 gm / 100 ml ns iv prn i ca <1.12 -norepinephrine 0.03-0.25 mcg/kg/min iv drip infusion -digoxin 0.125 mg po daily -pantoprazole 40 mg iv q24h -docusate sodium 100 mg po bid -potassium chloride 20 meq / 50 ml sw iv prn k <4.0 -furosemide 10 mg iv bid -propofol 5-30 mcg/kg/min iv drip titrate to sedation -heparin flush cvl (100 units/ml) 1 ml iv daily: -senna 1 tab po bid order date: @ 1128 -warfarin 4 mg po daily discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for t>101.5. 2. levothyroxine 75 mcg tablet : one (1) tablet po daily (daily). 3. atorvastatin 20 mg tablet : one (1) tablet po daily (daily). 4. docusate sodium 150 mg/15 ml liquid : one hundred (100) mg po bid (2 times a day). 5. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 6. amiodarone 200 mg tablet : one (1) tablet po daily (daily). 7. ipratropium bromide 17 mcg/actuation aerosol : four (4) puff inhalation q4h (every 4 hours) as needed for on vent. 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. clonazepam 0.5 mg tablet : one (1) tablet po tid (3 times a day). 10. lactulose 10 g/15 ml syrup : thirty (30) ml po q6h (every 6 hours) as needed. 11. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed. 12. digoxin 125 mcg tablet : 0.5 tablet po daily (daily). 13. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) unit injection tid (3 times a day): until inr therapeutic at . 14. loperamide 2 mg capsule : one (1) capsule po tid (3 times a day) as needed. 15. warfarin 5 mg tablet : one (1) tablet po hs (at bedtime). discharge disposition: extended care facility: northeast - discharge diagnosis: 1. respiratory failure post tracheostomy 2. atrial fibrillation 3. ventricular tachycardia 4. hypotension, initially from sepsis, then from overdiuresis 5. mrsa pneumonia discharge condition: stable discharge instructions: please return to ed or call your doctor if you have chest pain, shortness of breath, cough, dizziness, tenderness in your joints, fever or if there are any concerns at all followup instructions: 1. please follow up with dr. , b. within 2 weeks of your discharge 2. please follow up with your orthopedic surgeon procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube interruption of the vena cava arteriography of femoral and other lower extremity arteries percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy aortography pulmonary artery wedge monitoring other conversion of cardiac rhythm transfusion of packed cells other irrigation of wound infusion of vasopressor agent diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia severe sepsis gout, unspecified atrial fibrillation infection with microorganisms resistant to penicillins hemorrhage complicating a procedure methicillin susceptible pneumonia due to staphylococcus aureus other septicemia due to gram-negative organisms critical illness myopathy infection and inflammatory reaction due to other internal orthopedic device, implant, and graft other specified disorders of peritoneum septicemia due to serratia 

Answer: The patient is high likely exposed to