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: diarrhea/ams major surgical or invasive procedure: picc line placement blood transfusions history of present illness: mr. is an 80 year old russian-speaking man with a h/o colon cancer s/p hemicolectomy, bladder cancer s/p ureterostomy, htn, & ckd who presents to the after 2 days of diarrhea. the patient lives alone and today, he was found in bed covered in feces & complaining of rectal pain. per report, he was discharged from in after a gib requiring multiple units of blood. as part of his work-up, he was found to have metastatic disease in the liver of unknown primary on ct and ercp confirmed an ulcerated necrotic mass. a biliary stent was placed as part of his treatment and he was discharged on cefpodoxime to complete treatment on . his interval history is unclear, but he presents today with two days of diarrhea, described as watery, "constant," and without melena/hematochezia. in the ed, initial vs were: t98.8 p115 bp111/63 r20 o2 sat 100%ra. there, the patient denied f/c/n/v, cp, sob, abdominal pain, and was without diarrhea. labs revealed a wbc of 15.9 and a serum lactate of 6.0. he received iv vancomycin & zosyn as well as 2u prbc's and 3l ns, but he remained persistently tachycardic with hr's in the 100's. a ct abdomen/pelvis demonstrated constipation so he was disimpacted 700-800cc of guaiac positive brown stool. he was noted to have some minor skin irritation around the anal verge. at the end of the disimpaction, blood clots were noticed among the stool. a repeat lactate was 3.9. at the time of transfer, patient's vs were: t98.6 p120 bp126/74 r24 o2sat 99% on ra. on the floor, patient is alert, but mildly uncooperative, denying any pain. past medical history: #. saddle pulmanary emboli s/p ivc filter. - warfarin therapy eventually discontinued secondary to sdh #. left acoustic neuroma s/p xrt, left cerebello-pontine angle mass still present on subsequent imaging, stable since #. colon cancer (per chart, initially dx in with resection), per daughter was dx in (gib while on coumadin), underwent hemicolectomy with primary reanastomosis. no adjuvant chemo/xrt. note, path 13.x6cm mass, adenoca. margins clear but 2 of 18 ln examined were +cancer (t3n1). #. bladder cancer s/p bladder resection s/p ureterostomy #. recurrent utis #. lower back pain: l3-4 disc bulging, had admission in for inability to walk #. severe djd #. htn #. osa #. iron deficiency anemia #. hyperlipidemia # ckd, creat has been around 2.0 since , previously was 1.1, unclear etiology and was never worked up. social history: patient lives independently in apartment with 24 hour personal care attendants. per his family, he is alert & oriented x 1 at baseline. he has 2 daughters that live nearby. patient quit smoking more than 35 yrs ago after smoking about 15 pack-yrs. rare alcohol use. no illicit drug use. family history: no family history of premature coronary artery disease, sudden cardiac death, thyroid disease, colon cancer, diabetes, or hypertension. physical exam: vitals: t: 99.8 bp: 93/48 p: 58 r: 20 o2: 98%ra general: alert & oriented to self only, lying in bed, nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, or gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound or guarding, but large ventral hernia with urostomy located just inferior to the umbilicus with yellow urine draining into the ostomy bag. ostomy site is pink without exudate. rectal: mild erythema around the anal verge, no ulceration ext: cool, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 07:40pm cbc: wbc-15.9*# rbc-3.14*# hgb-6.6*# hct-23.4*# mcv-75*# mch-20.9*# mchc-28.1*# rdw-16.2* plt ct-441* diff: neuts-84.9* lymphs-11.4* monos-3.5 eos-0 baso-0.1 coags: pt-14.1* ptt-23.5 inr(pt)-1.2* chesmistries: glucose-195* urean-62* creat-1.6* na-134 k-5.3* cl-102 hco3-17* angap-20 alt-74* ast-71* alkphos-442* totbili-0.4 lipase-75* ld(ldh)-1163* albumin-2.6* calcium-7.7* phos-2.5* mg-2.1 freeca-1.14 iron studies: iron-18* caltibc-346 ferritn-72 trf-266 lactate trend: 07:56pm blood lactate-6.0* 08:38pm blood lactate-6.3* 02:00am blood lactate-3.9* 05:55am blood lactate-2.5* micro: **final report ** mrsa screen (final ): positive for methicillin resistant staph aureus blood culture, routine (final ): enterococcus sp.. unable to further speciate. final sensitivities. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: susceptible to 1000mcg/ml of streptomycin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details.. sensitive to daptomycin at 0.50 mcg/ml. sensitivities: mic expressed in mcg/ml ________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s daptomycin------------ s penicillin g---------- 2 s vancomycin------------ <=0.5 s imaging: cxr : single ap view of the chest: lung volumes are low, with linear opacities at the lung bases consistent with atelectasis. the cardiomediastinal silhouette is unchanged, with a tortuous aorta and mild cardiomegaly. there is no hilar or mediastinal enlargement. pulmonary vascularity is normal. impressions: bibasilar atelectasis, without other acute cardiopulmonary abnormality. ct a/p : 1. moderate pneumobilia with cbd stent in place, extending from mid cbd into the duodenum. wall thickening and inflammatory changes in the second portion of the mediastinum, likely related to ercp. no abnormalities of the pancreas noted on non-contrast ct. 2. rectum distended with fecal matter, likely impacted, with wall thickening and inflammatory change of the distal rectum. 3. large hypodense masses within the liver, incompletely characterized but concerning for metastases. 4. 3.4 cm soft tissue densities in the mesentery adjacent to the duodenum and pancreatic head, mass or enlarged lymph nodes. 5. extensive atherosclerotic disease. 6. bilateral hydroureter, with dilation of the ileal conduit to the level of the the abdominal wall hernia; unchanged from prior exams. 7. severe degenerative disease. lower extremity doppler: no evidence of left lower extremity deep vein thrombosis. tte: no obvious vegetations seen, but very limited image quality : abd ultrasound: diffusely heterogeneously echogenic liver with multiple areas of hypoechogenicity, concerning for diffuse metastatic disease brief hospital course: mr. is an 80 year old russian-speaking man with h/o multiple malignancies (bladder, colon, acoustic neuroma), chronic kidney disease, hypertension, new ampullary adenocarcinoma, and recent dx of metastatic disease of unknown primary who presented to the with diarrhea and enterococcal bacteremia. # septic shock: patient initally admitted to the icu and required ivfs along with peripheral vasopressors. blood cultures grew enterococcus sensitive to ampicillin and vancomycin. he was initially treated with broad spectrum antibiotics but eventually narrowed to ampicillin. because the patient refused to take po antibiotics, he was given iv ampicillin. at time of discharge, he was on iv ampicillin (10 days) without any other positive blood cultures. it was thought that his bloodstream infection may have originated in his biliary tree vs a gi source. as such, the plan at time of discharge was for a total 3 week course (10 days after discharge). the family declined a egd/ to evaluate for a definitive source of his bacteremia. he did undergo a tte which was unremarkable but a poor study. it was felt that the patient would be unable to tolerate tee with a low clinical risk of endocarditis. # gi bleed/iron deficiency anemia: patient has a baseline hct in low-30's & mcv in mid-70's since by omr records. on admission patient with hct below baseline to 23.4 and manual disimpaction revealed blood clots concerning for gi bleed. patient was tranfused 1u prbc and his hct increased appropriately. egd was planned, but later it was decided that an egd was not needed given his goals of care, and overall prognosis. on the floor, he had guiaic positive stools but no frank blood per rectum. he was given 2 more units of prbc and his hematocrit was stable at 30 at his time of discharge. # malignancies: patient with history of multiple malignancies including bladder, colon, and acoustic neuroma, now with report of an ulcerating necrotic mass seen on ercp at osh and a ct torso demonstrating multiple liver lesions, a large pericardial effusion, and stranding around the 2nd portion of the duodenum. new lesion is an ampullary adenocarcinoma per hospital records. given prognosis of metastatic cancer, a family meeting was held in which the family decided to make the patient dnr/dni with limited intervention, with the exception of antibiotic treatment for his presumed infection and pain control. oncology was consulted but given his poor performance status and multiple other co-morbities, they did not feel that systemic chemotherapy would not be recommended. patient is at risk for additional biliary obstructions as well as possible bowel obstructions and additional metastasis. he is also at risk of infection from cholangitis. they express that they would like the best quality of life for him, minimizing in invasive procedures. the goal would be to get his to rehab with antibiotics and see how he does clinically. patient's family is interested in hospice for symptoms control and will readdress depending how he does. # avnrt: several episodes of avnrt to hr 170s with bp 80-90s/50s-60s was noted when patient was sleeping. these arryhthmias were not responsive to vagal maneuvers but broke with 6mg iv adenosine each time. patient was put on metoprolol but continued to experience episodes of avnrt. a ccb was added with good effect. # decreased hearing: patient has history of l acoustic neuroma and bilateral cerumen plugs likely contributing. carbamide peroxide otic drops bilaterally was given twice a day. # chronic kidney disease: unknown etiology of ckd, but may be secondary to history of bilateral hydronephrosis. baseline cr 1.2-1.4. medications were renally dosed. a cr on admission was 1.6 and is 1.2 upon discharge. # dementia: at baseline, patient a&o x 1 and requires 24 hour assistance for all of his adl's at home. his family reported that his mental status during this hospitalization is consistent with his baseline. # recurrent uti: patient is status post ureterostomy for bladder cancer in leading to frequent uti's due to various pathogens resistant to cipro/bactrim/gent/unasyn. on admissions, ua was negative and patient had no urinary symptoms. # hyperlipidemia: diagnosis on online medical records, but patient not on medications at home. # osa: diagnosis on online medical records, but patient does not use cpap at home. medications on admission: lopressor 25mg po bid discharge medications: 1. senna 8.6 mg capsule sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed for itchiness. 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 7. verapamil 80 mg tablet sig: one (1) tablet po q8h (every 8 hours): hold for sbp < 100, hr < 55. 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp < 100, hr < 55. 9. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever. 10. lidocaine hcl 5 % ointment sig: one (1) appl topical qid (4 times a day) as needed for rectal pain. 11. hydrocortisone acetate 1 % ointment sig: one (1) appl rectal (2 times a day). discharge disposition: extended care facility: of discharge diagnosis: primary: enteroccoccal bacteremia cholangitis dementia hearing loss hemorroids avnrt secondary: ampullary adenocarcinoma metastatic disease of the liver discharge condition: mental status: confused - always level of consciousness: alert and interactive activity status: bedbound discharge instructions: you were admitted to the hospital for diarrhea and changes in your thinking. you were in the intensive care unit (icu) when you were first admitted to the hospital. you were given antibiotics and found to have a bacteria called enterococcus in your blood. this went away with antibiotics. since you did not want to take oral antibiotics, a picc line was placed. you have 9 more days of ampicillin antibiotics left to complete your course (last dose ). because bacteria were found in your blood, you had a tte (an ultrasound of your heart) to look for infection on the heart valves. there was no infection seen on the heart valves. you also developed painful hemorrhoids which improved with steroid cream. you were given blood transfusions for a falling blood count. given the slow decline of your blood count, this may be partially a result of frequent blood draws. there was some microscopic blood in your stool as well and you may be losing some blood in your stool. given that you had no active signs or symptoms of rapid blood loss you were given transfusions as needed. it was felt that further testing would be harmful to your health. your heart rate was very fast several times while you were in the hosiptal. you were given meds to control your heart rate. followup instructions: please follow up with dr by calling his office at . procedure: venous catheterization, not elsewhere classified diagnoses: malignant neoplasm of liver, secondary iron deficiency anemia secondary to blood loss (chronic) severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified unspecified disease of pericardium other specified cardiac dysrhythmias septic shock unspecified hearing loss personal history of malignant neoplasm of bladder personal history of malignant neoplasm of large intestine other constipation hemorrhage of gastrointestinal tract, unspecified streptococcal septicemia cholangitis malignant neoplasm of ampulla of vater personal history of irradiation, presenting hazards to health personal history of methicillin resistant staphylococcus aureus acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to