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: vancomycin / oxycodone / lorazepam attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 89 yo m with tracheo-bronchomalazcia s/p stents , multiple bronchoscopy, s/p tracheostomy , s/p tracheal decannulization in , copd, paf, cad, and other medical issues transferred from with of pna, copd exacerbation, and possible avr given as. . per report, patient was readmitted to after being home for a few days (, ). for his initial admission , he was treated with levofloxacin and steroid. he represented with sob and underwent bronchoscopy (pre-scheduled) that found large amount of secretion. after mucous plug removal, his respiratory status improved, but still had dyspnea on exertion and hypoxia down to the 80s. he was given antibiotics with imipenem (esbl e. coli), linezolid (history of mrsa, allergy to vanco), nebs, o2 supplement, and steroid. pulmonary consult at recommended discontinuation of the antibiotics if his patchy infiltrate improved. . upon transfer, vs were 97.4f, p 74, bp 141/68, rr 15, o2 sat 98% on 4l. . on the floor, patient reports some dyspnea, especially with exertion, worse with the copd exacerbation. he reports having copd exacerbation requiring up to 3-4l o2, then was sent home on 40 mg prednisone, levoquin, and o2. of note, prior to the copd exacerbation, he states no o2 requirement. subsequently returned to hospital because he felt the copd exacerbation was worse again. thus, prompting bronchoscopy. he states that he is usually not on any home oxygen until this copd exacerbation. has been having several months of orthopnea and pnd. he reports chest discomfort with coughing but not with exertion. denies palpitation, dizzziness, lightheadedness, or presyncope. he does not think he has le edema but was told that he has it in . he wants to make sure his cardiologist and pulmonologist are informed of his admission today. past medical history: - tracheo bronchomalacia s/p stent and multiple bronchs - s/p tracheostomy - stage iii copd - paroxysmal atrial fibrillation - cad s/p cabg - ckd (baseline creatinine 1.5-2.1) - aortic stenosis - prostate ca - cll - hypertension - hyperlipidemia - gerd - depression - vit b12 defic - arthritis - ventral hernia - hx of enterococcal urosepsis - cholecysttectomy psh: silicon wire stent placement in , s/p cabg and then stent within last 10 years, ccy social history: - he lives alone in a senior's facility. he is retired and formerly was in airline sales and is also a veteran. - his wife died 2 ago. - he smoked a pipe for 10 years and quit 35 years ago. - alcohol: seldom - illicits: denies family history: no family history of pulmonary disease physical exam: admission physical exam: vitals: t: 96 bp: 127/84 p:72 r:23 o2: 93% 4l general: alert, oriented, no acute distress heent: sclera anicteric, mucous membrane dry, oropharynx clear neck: supple, jvp up to mid-neck, no lad lungs: upper airway sound with barking cough/stridor, + crackles in the rll, no wheeze cv: regular rate and rhythm, normal s1 + s2, + 2/6 sem in the lusb and also in the llsb abdomen: soft, non-tender, obese, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: cool, well perfused, 1+ pulses, no clubbing, cyanosis or edema discharge physical exam: vitals: 97.4 92/52 69 22 94%4l general: alert, oriented, no acute distress heent: sclera anicteric, mucous membrane slightly dry, oropharynx clear neck: supple, jvp up to mid-neck, no lad lungs: rhonchi/crackles b/l, moving good air in posterionr and anterior lung fields cv: regular rate and rhythm, normal s1 + s2, + 2/6 systolic murmur in the rusb and apex abdomen: soft, non-tender, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema skin: multiple minor bruises in extremity, picc intact pertinent results: labs on transfer from : 05:46pm glucose-228* urea n-42* creat-1.3* sodium-134 potassium-5.1 chloride-100 total co2-25 anion gap-14 05:46pm calcium-8.0* phosphate-2.7# magnesium-2.3 05:46pm wbc-15.2*# rbc-4.01* hgb-12.0* hct-36.8* mcv-92 mch-29.8 mchc-32.5 rdw-15.6* 05:46pm plt smr-low plt count-123* 05:46pm pt-25.3* ptt-24.8 inr(pt)-2.4* labs on discharge: 10:29am blood wbc-17.0* rbc-3.89* hgb-11.9* hct-35.9* mcv-93 mch-30.7 mchc-33.1 rdw-15.9* plt ct-115* 10:29am blood neuts-69.3 lymphs-29.2 monos-1.0* eos-0.1 baso-0.4 07:48am blood pt-28.3* ptt-30.5 inr(pt)-2.7* 07:48am blood glucose-149* urean-44* creat-1.3* na-134 k-4.6 cl-96 hco3-31 angap-12 07:48am blood calcium-8.2* phos-2.8 mg-2.3 ap cxr: impression: 1. low lung volumes with atelectasis, more on the right, but no definite evidence for pneumonia. echo the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. the aortic valve is not well seen. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: brief hospital summary 89 yo m with tracheo-bronchomalazcia s/p stents , multiple bronchoscopy, s/p tracheostomy , s/p tracheal decannulization in , copd, paf, cad s/p cabg transferred for of avr and possible tracheoplasty, neither of which are an option for this patient, per the consulting services. his copd exacerbation has been treated and the patient has been stabilized. . active issues # copd exacerbation, potentially cap. found to have esbl e. coli on bronchoscopy at osh. given history, clinical picture and other underlying comorbidities and allergy to vanc, pt on linezolid and meropenem, w/ symptomatic improvement. seen by interventional pulm. picc placed. pt w/ some coughing this am. pt w/ significant crackles and rhonchi. dyspnea and saturations stable in past 48 hours, aside from some episodes of coughing. seen by pt yesterday w/ preserved ambulatory sats on 4l o2 (low 90%s). wbc had increased today on initial cbc (from 14->22), but a repeat cbc a matter of hours later showed a wbc of 17 (not significantly different from admission of 15.2). thus, the 22.0 was likely a spurious lab test, and repeat diff reassuring. sending additional labs regardless (c.diff, ua), but we believe this is most probably the effect of steroid initiations. we appreciated pulmonology recs, which recommended outpt f/u and no interventions. throughout the pt's hospitalization, he was on 40mg prednisone (aside from 60mg on day one). pt sent to rehab on following taper: take 40mg for 7 days, followed by 30 mg for 7 days, followed by 20mg for 7 days. your pulmonologist should see you before you go down any further. will continue antibiotics for 14 days considering considerable structural disease and potential hospital acquired pneumonia, will finish linezolid on and meropenem on . we gave albuterol and ipratropium nebs q6hrs and guaifenesin q6hrs standing, tessalon perles for cough, which improved pt's cough. we gave supplemental nc at 4l goal o2 sat > 91% and <96%. we obtained a pt consult w/ ambulatory sats (no significant decrement). . # aortic stenosis, moderate in 5/. pt w/ repeat echo (see above) w/ avalve 1-1.2cm, and no immediate plan for plasty or repair by cardiology. pt w/ mild crackles b/l but no elevated jvp. no le edema. . # paroxysmal atrial fibrillation. currently in sinus. asymptomatic. inr 2.7. we monitored on tele, continued amiodarone 200 qd, metoprolol 25 and warfarin 1mg qd. we contact the patient's cardiologist to communicate his admission. . # dchf. ef > 55% in 5/. repeat echo demonstrated ef > 55%. pt w/ crackles, rhonchi b/l but no elevated jvp. patient denies taking lasix at home but was on it upon last discharge in 8/. continued 20mg lasix per day. . # cad. h/o cabg in , cardiac cath in with thrombotic occlusion of the venous graft to d1, but not suitable for intervention. pt had chest pain w/ exertion in icu, w/ hypotension 150 --> 90 w/ nitro sublingual. we continued metoprolol 25 mg . we continued atorvastatin. if pt has cp, be cautious use of nitro, as pt became hypotensive. . # tbm. no hypoxia on 4l. seen by interventional pulm, and no indication for intervention. transitional issues: 1. f/u pulm clinic 09:00a / copd,tcc sc clinical ctr, pulmonary unit-cc7 (sb) 2. f/u c. diff and ua/cx pnd 3. two week total course of meropenem and linezolid 4. prednisone taper 7 days 40mg, 7 days 30mg, 7 days 20mg, then see pulmonologist before then. medications on admission: per discharge summary 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po hs (at bedtime). 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. amoxicillin 500 mg tablet sig: one (1) tablet po every eight (8) hours for 10 days. 6. aspirin low dose 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 7. mucinex 1,200 mg tablet, er multiphase 12 hr sig: one (1) tablet, er multiphase 12 hr po twice a day. disp:*60 tablet, er multiphase 12 hr(s)* refills:*2* 8. fluticasone 250 mcg/actuation disk with device sig: two (2) puffs inhalation twice a day. disp:*1 device* refills:*2* 9. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. disp:*30 capsules* refills:*2* . transfer medication from - amiodarone 200 mg daily - atorvastatin 80 mg qhs - metoprolol tartrate 50 mg every day - tiotropium inhaled daily - prednisone 60 mg daily, day 1, , last dose 10/30 - ipratropium/albuterol 0.5 mg-2.5 mg 1 neb q4h - warfarin 1 mg daily - imipenem with cilastatin 500 mg q12 ghr, day 1 = , last dose 10/30 - linezolid 600 mg q12 hr, day 1 = , last dose 10/30 - atropine 1 mg push prn - lidocain iv push prn - milk of magnesia 10 ml - nitrostat 0.4 mg tab - tylenol 500 mg q6h prn - xanax 0.25 mg q6h prn - robitussin 200 mg q4h prn discharge medications: 1. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 3. prednisone 20 mg tablet sig: two (2) tablet po daily (daily): take 40mg for 7 days, followed by 30 mg for 7 days, followed by 20mg for 7 days. your pulmonologist should see you before you go down any further. . disp:*100 tablet(s)* refills:*0* 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 7. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 8. guaifenesin 100 mg/5 ml syrup sig: ten (10) ml po q6h (every 6 hours). 9. benzonatate 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for cough. 10. insulin lispro 100 unit/ml solution sig: one (1) insulin sliding scale subcutaneous asdir (as directed): see attached insulin worksheet. insulin sliding scale continued while patient on prednisone and in rehab. . 11. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 8 days: until . first day on . . 12. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 13. linezolid 600 mg/300 ml parenteral solution sig: one (1) intravenous q12h (every 12 hours) for 7 days: through . started . 14. atorvastatin 20 mg tablet sig: one (1) tablet po once a day. 15. aspirin low dose 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: copd exacerbation secondary to bacterial pneumonia secondary diagnoses: cad, atrial fibrillation, aortic stenosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to our hospital for a copd exacerbation which was most likely caused by a bacterial pneumonia. as you know, you have significant structural disease in your lungs. we are giving you antibiotics, nebulizer treatments and steroids to treat this ailment. you improved while here with your breathing. while here, you were seen by the pulmonologists and the cardiologists. the following changes were made to your medications: we added an insulin sliding scale while you are on prednisone and we are monitoring. start benzonatate 100 mg po bid:prn cough @ 1017 view start guaifenesin 10 ml po/ng q6h cough @ 1017 view start famotidine 20 mg po/ng q12h @ 2112 view start albuterol 0.083% neb soln 1 neb ih q6h wheeze and sob @ 2112 view start ipratropium bromide neb 1 neb ih q6h sob and wheeze @ 2112 view start prednisone 40 mg po/ng daily @ 2112 view. your rehab should taper you down as they see fit, potentially 7 days of 40 mg, followed by 7 days of 30mg followed by 7 days of 20mg. you should see your pulmonologist before you go down more than that. start linezolid 600 mg iv q12h day 1 = first day in osh was @ 2112 view start meropenem 500 mg iv q8h day 1 = first day in osh . @ 2112 view changed metoprolol tartrate to 25mg from 50mg on your last discharge from this hospital. hold: mucinex 1,200 mg tablet, er multiphase 12 hr sig: one (1) tablet, er multiphase 12 hr po twice a day. hold fluticasone 250 mcg/actuation disk with device sig: two (2) puffs inhalation twice a day. hold spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. aside from these changes, please continue to take all of your prior medications. followup instructions: department: medical specialties when: monday at 9:00 am with: rn/dr. building: sc clinical ctr campus: east best parking: garage *this appointment is with a specialist who will focus directly on copd management as you transition from the hospital to home. after this visit, dr. will follow your care. you will be contact if this appointment changes. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified esophageal reflux congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids atrial fibrillation personal history of malignant neoplasm of prostate obstructive chronic bronchitis with (acute) exacerbation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders depressive disorder, not elsewhere classified other and unspecified hyperlipidemia long-term (current) use of anticoagulants chronic diastolic heart failure chronic lymphoid leukemia, without mention of having achieved remission other diseases of trachea and bronchus arthropathy, unspecified, site unspecified 

Answer: The patient is high likely exposed to