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 / ventolin hfa attending: chief complaint: low back pain major surgical or invasive procedure: replacement of suprapubic catheter picc line placement history of present illness: 30 y/o f with spinabifida presents with mid lower back pain and bilateral flank pain starting 5 days ago (last friday) and worsening over time. on arrival to the floor, the pain is . the pain radiates to the front, suprapubically. does not radiate up her back or down her legs. has suprapubic tube that she has not changed recently. she usually changes it on her own at home with the help of her cousin. she noticed that it has been leaking small amounts of urine from the catheter site. she also notices her urine has been red the last several days. has a history of utis with mrsa and enterococcus r to cipro and s to bactrim. pt denies fever or chills, although states she has been sweaty at times last several days. . pt also having some abdominal pain. has not had a bowel movement in about two weeks, usually has one every several days. does have chronic constipation problems. had nausea and vomitting x3 today, non bloody or bilious emesis. pt is hungry. . pt also has complained of some chest pain starting in the ambulance ride over. the pain does not radiate, not diaphoretic. associated with some shortness of breath that has since resolved. ekg in emergency room was normal. has hx of atypical chest pain and gerd. . pt also has noticed some increased muscle spasms in her r leg, has it chronically, but it has been increasing last several days. past medical history: pmh: 1. spinabifida with hydrocephalus, vp shunt, chiari malformation 2. siezures ? 3. utis/pyelonephritis with suprapubic cath 4. ovarian cysts 5. sacral decubitus ulcer 6. atypical chest pain 7. hx of pe with vena cava filter (placed at about 1 yr ago) social history: pt living with her mother, cousin helps with activities of daily living, uses wheelchair, needs assistance with ambulation. smokes 1 ppd, no alcohol, no illicit drugs family history: nc physical exam: physical exam: vitals: t: 9609 bp: 99/86 p: 81 rr: 13 o2sat: 100% gen: heent: clear op, mmm neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or gallops lungs: cta, bs bl, no w/r/c abd: soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: no lesions neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: imaging: . cxr - single ap view of the chest in upright position demonstrates low lung volumes. bibasilar subsegmental atelectasis. the cardiomediastinal silhouette is within normal limits. there is no pneumothorax, consolidation, or pleural effusion. a left-sided vp shunt is seen with the distal portion coiled in the left upper abdomen. an old vp shunt is seen on the right with the uppermost portion projecting over the right mid lung zone. thoracolumbar scoliosis is again seen. . ct tl spine: impression: 1. spina bifida. no fracture or subluxation. 2. mild bilateral renal pelviectasis, new since . 3. small bilateral pleural effusions. 4. stable cystic lesion in the right adnexa. 5. mr should be considered if there is clinical concern of intraspinal lesions such as infection or hemorrhage. . renal us: impression: unremarkable renal ultrasound with no hydronephrosis seen. . ct of head: a new left frontal approach intraventricular catheter terminates in the frontal of the left lateral ventricle adjacent to the foramen of . the lateral and third ventricles have increased in size since . there is no acute intracranial hemorrhage, shift of normally midline structures or major vascular territorial infarct. tectal beaking is unchaged. there is mucosal thickening and aerosolized secretions in the right maxillary sinus, and a left maxillary sinus mucus retention cyst. impression: 1. interval enlargement of the lateral and third ventricles, concerning for shunt malfunction. 2. stigmata of chiari 2 malformation again noted.. 3. aerosolized secretions in the right maxillary sinus, which may indicate acute sinusitis. . lower extremity us: no dvt labs: 10:00am blood wbc-13.5*# rbc-4.88 hgb-9.4* hct-34.3* mcv-70* mch-19.3* mchc-27.4* rdw-16.7* plt ct-397 04:02am blood wbc-10.7 rbc-4.57 hgb-8.9* hct-33.1* mcv-72* mch-19.4* mchc-26.8* rdw-17.0* plt ct-347 05:54am blood wbc-9.4 rbc-4.23 hgb-8.3* hct-29.7* mcv-70* mch-19.6* mchc-27.9* rdw-17.7* plt ct-372 10:00am blood glucose-159* urean-5* creat-0.4 na-135 k-3.6 cl-103 hco3-20* angap-16 04:02am blood glucose-117* urean-3* creat-0.4 na-140 k-4.3 cl-103 hco3-30 angap-11 05:54am blood glucose-114* urean-3* creat-0.4 na-142 k-4.5 cl-104 hco3-32 angap-11 10:00am blood alt-22 ast-15 ck(cpk)-726* alkphos-89 totbili-0.1 05:18pm blood alt-22 ast-13 alkphos-91 totbili-0.1 10:00am blood lipase-17 10:00am blood ck-mb-15* mb indx-2.1 10:00am blood ctropnt-<0.01 11:44pm blood caltibc-330 ferritn-14 trf-254 11:44pm blood tsh-1.7 10:04am blood glucose-144* lactate-3.2* na-135 k-3.4* cl-103 calhco3-21 brief hospital course: pt was admitted for back pain. we started her empirically on vanco/ceftriaxone for presumed pyelo vs. uti because of her history of frequent infections. her urine was not infected (seems to be contaminated), and renal us was normal. tried to control the pain and imaged spine with ct scan. unable to mri spine per neurosurg because of her adjustable shunt. were unable to see any pathology for her pain on ct scan, but cannot rule out abscess or other smoldering neurological problem. neuro exam has remained unchanged throughout visit. she likely does not have an acute neurological emergency, but would ultimately like to image back. . of note, on the third day of admission, her blood pressure reportedly dropped to 70-80. she felt dizzy. she had no access, so no boluses could be given. she was transferred to the micu for management of the hypotension. on arrival to the micu her sbp was 108. she was no longer complaining of dizziness. of note, she recieved a dose of morphine at noon and her first dose of oxybutynin at 230. the hypotension occured around 5pm. has not had any hypotension since then. . she also has been having fevers. she spiked to 101.2 on . started on vanco/ceftriaxone again. they had been stopped when infection seemed unlikely. id was consulted. she continued to have low grade fevers and feel hot/chills. id thought that possibly it was due to dvt, but le us was negative. unknown source of fever, another reason we would like to image the back. is to complete 5 day course of ceftriaxone from the when it was started per id recommendations. . other problems addressed during this admission were eye irritation treated with eye drops, constipation for 3 weeks treated with aggressive bowel regimen, sacral wound examined by the wound nurse and found to be healing appropriately, and probable sleep apnea which we suggest be followed up as an outpatient. . she also continued to sometimes leak from her suprapubic catheter. it was changed twice as an inpatient and unknown why it is still leaking. says it happens at home a lot. were considering just increasing the size of the catheter. no infection. see below for microbiology to date: . urine: mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. . urine: urine culture (final ): probable enterococcus. ~1000/ml. . no other urine or blood has grown anything up to date. medications on admission: medications on admission: home meds: gabapentin docusate folic acid vit b / folic acid tizanadine ompeprazole benadryl discharge medications: 1. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 7. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 8. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 9. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 10. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 11. morphine 15 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed. 12. ibuprofen 600 mg tablet sig: one (1) tablet po tid (3 times a day). 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 14. ceftriaxone-dextrose (iso-osm) 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 2 days: are completing total of 5 day course per id recs. discharge disposition: extended care discharge diagnosis: primary diagnosis: 1. back pain 2. fevers (unknown source) 3. hypotension 4. spinabifida discharge condition: vital signs stable, sbps around 90-100, febrile to 99.9 yesterday, with 7/10 back pain, ambulating in her wheelchair with help, normal mentation. discharge instructions: you were admitted to the hospital for low back pain. we tried to treat you pain with medicines but it continued. we did a ct of your spine to rule out bony abnormalities, and it was negative. ultrasound of your kidneys were negative, too, so we didn't think you had a kidney infection. we were unable to determine the cause of your back pain. we really think you should get an mri for further workup, and we can't give you one here because our neurosurgeons cannot readjust your shunt after the imaging. . you also had some low blood pressure during your stay. we think it may have been from some of the pain medicines we were giving you. we took you to the icu for closer mointoring. they were able to get a picc line in and give you fluids to help your blood pressure. . you also spiked fevers during your hospital stay. we don't know what is causing this, so that is another reason we think you should have an mri, to rule out any possible infections in your back. . we will transfer you to where your shunt was placed and they will be able to do an mri there. followup instructions: transferred to , they can discuss follow up when you are discharged procedure: venous catheterization, not elsewhere classified replacement of indwelling urinary catheter diagnoses: other iatrogenic hypotension constipation, unspecified pressure ulcer, lower back urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure backache, unspecified presence of cerebrospinal fluid drainage device history of fall neurogenic bladder nos mechanical complication due to urethral (indwelling) catheter spina bifida with hydrocephalus, unspecified region continuous leakage 

Answer: The patient is high likely exposed to