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: no known allergies / adverse drug reactions attending: chief complaint: poor wound healing, left lower extremity ischemia major surgical or invasive procedure: : 1. bilateral groin cutdowns. 2. left-to-right femoral-femoral artery bypass graft placement. 3. left femoral artery-to-above-knee popliteal artery bypass graft with non-reversed saphenous vein graft. : 1. exploration of left-to-right femoral-femoral artery bypass graft and left femoral-to-above-knee popliteal artery bypass graft. 2. thrombectomy of femoral artery-to-femoral artery bypass graft and left femoral artery-to-above-knee popliteal artery bypass graft and embolectomy of left aortofemoral bypass graft. 3. bovine patch angioplasty of proximal anastomosis of left femoral-to-above-knee popliteal artery bypass graft and vein patch repair of femoral-popliteal bypass. 4. aortogram. 5. selective catheterization of the femoral artery-to- femoral artery bypass graft and of the left femoral-to- above-knee popliteal bypass graft. 6. serial arteriogram of the left lower extremity. : left groin irrigation and debridement with sartorius muscle flap coverage of the vascular anastomosis and vacuum assisted dressing closure. history of present illness: 53 y/o f pmhx iddm, extensive vascular disease, and poor wound healing was a transfer from center with concern for b/l foot osteomyelitis. she has a prior history of a chronic l foot ulcer s/p i& post with 6 week course of linezolide; r 2nd toe amputation for wet gangrene. 4 days prior to admission, vna noted increased erythema surrounding l foot ulcer after the pt wore wet shoes the day prior. denies any addition s/sx including: discharge, f/c, cough, sob/cp, n/v/d, abd pain, n/t/w (decreased b/l foot sensation at baseline), ha, or pain located over l or r foot ulcers, gi/gu frequency. continues to ambulate with cane. no exacerbating or relieving factors. identical to prior wound infections. . whilst at hospital, pt started on vanco, evaluated by dr. , and had mri that showed questionable osteomyelitis; vanco changed to daptomycin for unclear reason upon chart review or questioning pt; no noted adverse reactions to vancomycin. pt transfer to for podiatry and vascular eval. in addition, inr noted to be > 3 and coumadin was held on admission. past medical history: type 2 diabetes mellitus copd/asthma atrial fibrillation chronic on coumadin hyperlipidemia mdd chronic anemia osteomyelitis - l foot s/p i& peripheral vascular disease s/p amputation of r 2nd toe ; l abi 0.79, r 0.45 mediastinal adenopathy charcot feet deformity social history: disabled, history of remote tobacco use (20pyh). denies drug, and alcohol use lives with grandson; able to do adl's independently family history: brother, sister, father with dm physical exam: vs: t 97.7 bp 142/82 hr 50 sao2 98%ra general: alert, oriented, no acute distress 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, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, dopplerable dp pulses b/l skin: l foot: 1cmx4cm linear stage 3 ulcer along arch with marked area of erythema, no discharge, 1cm round stage 2 ulcer over 1st metatarsal; r foot: 2nd toe amputated with 1cm round stage 2 ulcer, and 1st metatarsal with 1cm round stage 2 ulcer; l groin with wound vac pulses: dopplerable dp/pt bilat neuro: cn 2-12 grossly intact; sensation below motor: 5/5 strength through ue/le bil sensation: decreased 2pt and proprioception at toes bil dtr: wnl pertinent results: 06:47am blood wbc-10.5 rbc-3.64* hgb-10.1* hct-30.6* mcv-84 mch-27.7 mchc-32.9 rdw-16.7* plt ct-587* 05:08am blood wbc-9.2 rbc-3.46* hgb-10.0* hct-29.0* mcv-84 mch-28.8 mchc-34.3 rdw-16.5* plt ct-596* 05:20am blood wbc-8.9 rbc-3.50* hgb-9.7* hct-29.5* mcv-84 mch-27.8 mchc-33.0 rdw-15.7* plt ct-565* 05:08am blood pt-21.2* ptt-28.9 inr(pt)-2.0* 05:20am blood pt-23.3* ptt-28.4 inr(pt)-2.2* 05:32am blood pt-24.1* inr(pt)-2.3* 06:02am blood pt-21.7* inr(pt)-2.0* 11:39am blood glucose-154* urean-28* creat-1.0 na-133 k-3.8 cl-97 hco3-29 angap-11 05:00am blood glucose-55* urean-28* creat-1.1 na-133 k-3.9 cl-97 hco3-31 angap-9 05:24am blood glucose-110* urean-32* creat-1.3* na-131* k-4.2 cl-96 hco3-30 angap-9 05:36am blood glucose-148* urean-34* creat-1.3* na-132* k-3.8 cl-93* hco3-32 angap-11 06:47am blood glucose-106* urean-33* creat-1.2* na-130* k-3.9 cl-95* hco3-29 angap-10 05:08am blood glucose-138* urean-32* creat-1.1 na-133 k-3.8 cl-97 hco3-28 angap-12 05:20am blood glucose-106* urean-31* creat-1.1 na-136 k-4.3 cl-101 hco3-31 angap-8 06:47am blood calcium-9.0 phos-3.9 mg-2.0 05:08am blood calcium-8.4 phos-3.1 mg-1.8 05:20am blood calcium-9.1 phos-3.1 mg-1.9 06:35am blood %hba1c-11.0* eag-269* 06:35am blood triglyc-95 hdl-44 chol/hd-2.4 ldlcalc-42 09:39am blood tsh-0.090* 01:10pm blood tsh-0.16* 04:11am blood tsh-0.20* 04:45am blood tsh-0.14* 05:56am blood tsh-0.074* 06:47am blood tsh-0.088* 06:02am blood tsh-pnd 06:45am blood t4-6.5 t3-98 calctbg-0.86 tuptake-1.16 t4index-7.5 free t4-1.2 01:10pm blood t4-5.2 t3-91 calctbg-0.88 tuptake-1.14 t4index-5.9 04:11am blood t4-5.8 t3-76* calctbg-0.82 tuptake-1.22 t4index-7.1 06:47am blood t4-10.2 t3-117 calctbg-0.82 tuptake-1.22 t4index-12.4* 06:47am blood crp-67.2* 10:00 am swab left groin. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. dr. requested further work-up . pseudomonas aeruginosa. sparse growth. escherichia coli. sparse growth. piperacillin/tazobactam sensitivity testing available on request. escherichia coli. rare growth. 2nd morphology. piperacillin/tazobactam sensitivity testing available on request. escherichia coli. rare growth. 3rd morphology. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | escherichia coli | | escherichia coli | | | escherichia coli | | | | amikacin-------------- 16 s ampicillin------------ =>32 r =>32 r =>32 r ampicillin/sulbactam-- =>32 r 16 i 16 i cefazolin------------- 8 s <=4 s <=4 s cefepime-------------- 8 s <=1 s <=1 s <=1 s ceftazidime----------- 4 s <=1 s <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s <=1 s ciprofloxacin--------- =>4 r =>4 r =>4 r =>4 r gentamicin------------ =>16 r <=1 s <=1 s <=1 s meropenem------------- 8 i <=0.25 s <=0.25 s <=0.25 s piperacillin/tazo----- 16 s tobramycin------------ =>16 r <=1 s <=1 s <=1 s trimethoprim/sulfa---- =>16 r =>16 r =>16 r anaerobic culture (final ): no anaerobes isolated. 5:22 am blood culture source: line-cvl. **final report ** blood culture, routine (final ): no growth. 3:41 pm swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): no vre isolated 7:58 am swab source: left foot. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): beta streptococcus group b. sparse growth. susceptibility testing requested by dr. # . sensitivity testing performed by sensititre. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . staphylococcus, coagulase negative. rare growth. susceptibility testing requested by dr. # . coag neg staph does not require contact precautions, regardless of resistance 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. sensitivities: mic expressed in mcg/ml _________________________________________________________ beta streptococcus group b | staphylococcus, coagulase negative | | clindamycin----------- r <=0.25 s erythromycin---------- =>4 r <=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g----------<=0.06 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ <=1 s <=0.5 s anaerobic culture (final ): no anaerobes isolated. discharge labs: 140 105 31 50 agap=11 ------------- 4.4 28 0.8 estgfr: 75 / >75 (click for details) ca: 9.0 mg: 1.7 p: 3.6 pt: 18.6 ptt: 25.7 inr: 1.7 brief hospital course: 53yo f pmhx iddm, extensive vascular disease, and poor wound healing presenting with s/sx concerning for osteomyelitis and cellulitis of l foot ulcers. she was admitted to the medicine service for management of her osteomyelitis, foot ulcers, and multiple comorbidities, and was followed by podiatry bilateral charcot deformities. vascular surgery was consulted for concern for inadequate vascularization and further work-up revealed occlusion of her previous aorto-bifem graft. at that point, she was transferred to the vascular surgery service for further management. she was taken to the or for left-to-right fem-fem bypass and left femoral to above-knee popliteal artery bypass. this was complicated by graft thrombosis requiring take-back to the or the same night for thrombectomy. she required massive fluid resuscitation during the perioperative period, which caused respiratory and cardiac difficulties. neuro: her pain was well-controlled with oral and iv pain medications. she was intubated briefly in the post-operative period, sedated on fentanyl and versed, but responded appropriately when sedation was lightened. after extubation, she awoke and was alert and oriented, without neurologic deficits and no neurologic issues for the rest of her hospitalization. cv: she has chronic atrial fibrillation, which was well-controlled on her home medications until her massive fluid resuscitation. at that time, she went into afib with rvr, which required esmolol and diltiazem drips while in the icu for heart rate control. once her volume status improved, she was re-started on her home medications with good rate control and had no further issues during the course of her hospitalization. pulm: she has copd at baseline, which is well-controlled with inhalers. she was intubated for the or and could not be extubated until pod 3 due to her volume status. she had acute pulmonary edema and was heavily diuresed with lasix. once extubated she required intermittent bipap for a few days, and was then weaned to nasal cannula. her oxygen requirements continued to decrease as her volume status improved, until she was not requiring supplemental oxygen for the majority of her hospitalization. fen/gi: she required massive fluid resuscitation in the perioperative period, and was nearly 20 liters positive post-operatively. once her atrial fibrillation was controlled and her blood pressure stable, she was gently diuresed with a lasix drip. her electrolytes were monitored and repleted appropriately, and her kidney function remained stable. she received tube feeds for several days post-op, and began eating her regular diet once extubated. nutrition was consulted and provided recommendations to optimize intake to improve wound healing. dr. from podiatry recommended midfoot/forefoot reconstruction at a further date as an oupatient for charcot's foot. she should call the podiatric surgery clinic for further follow-up of this condition at (. gu: her kidney function was monitored regularily and remained stable. heme/id: she was admitted for management of left foot ulceration, cellulitis, and osteomyelitis. her x-rays on admission were concerning for osteomyelitis, and wound cultures grew group b strep and mrse. she was treated with vanco/cipro/flagyl. she was kept on a heparin drip for a-fib perioperatively, and then transitioned back to coumadin. picc was placed on for long term abx and temporary central line removed. she was given 1 unit of rbcs on for hct of 28, post transfusion hct showed no response. wound cultures from the or on grew out multi drug resistant pseudomonas aeruginosa and 3 morphologies of e.coli. infectious disease was consulted and recommended cefepime 2 gm and metronidazole 500 mg po tid. with duration of therapy 6 weeks following last debridement. she should have weekly cbc/diff, bun/cr, and lft's while on the above therapy; please have labs faxed per the opat note to id rn's at . endo: she has poorly controlled type 2 diabetes. we consulted endocrinology for recommendations for blood sugar control while admitted. a pre-op chest x-ray also revealed a large substernal thyroid mass causing tracheal deviation. endocrinology also evaluated her for this process and recommended outpatient biopsy with likely removal by thoracic surgery. she was continued on methimazole and tfts monitored throughout her hospitalization. endocrinology has recommended that she follow up with her outpatient endocrinologists in weeks after discharge with a repeat of her thyroid function tests (tfts). left lower extremity wounds: she had left groin wound dehiscence and large amounts of serous drainage postoperatively. on , she was taken to the operating room for left groin wound debridement, sartorius flap, and vac placement. her vac was changed every three days while in the hospital. her left and right foot ulcers were debrided and treated with santyl ointment which should continue at discharge. at the time of discharge she was stable. her inr was 1.7 and she was continued on coumadin 5mg qhs. the vac was removed from her left groin wound and it was packed with wet to dry dressing. the vac should be replaced at the rehab facility. she will continue antibioitcs as indicated and follow up with the clinic, the podiatry clinic and the vascular surgery clinic. medications on admission: omeprazole 40mg po daily imdur 30mg po qday hydralazine 10 po tid metoprolol 100mg po bid lipitor 20mg po qday lexapro 10mg po qday combivent 2 puffs qid prn ventolin hfa 2 puffs q4hrs prn mvit qday ferrous sulfate 325mg po qday coumadin 5mg qday lantus 80u subq daily humalog ss cardizem 240mg po qday discharge medications: 1. ceftazidime 2 gram recon soln sig: two (2) grams injection q8h (every 8 hours) for 6 weeks: start date for 6 weeks. stop date . disp:*qs * refills:*0* 2. heparin, porcine (pf) 10 unit/ml syringe sig: 2 ml mls intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. . 3. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): start date cont for 6 weeks stop date . 4. collagenase clostridium hist. 250 unit/g ointment sig: one (1) appl topical daily (daily). 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day) as needed for constipation. 6. diltiazem hcl 120 mg capsule, sustained release sig: two (2) capsule, sustained release po daily (daily). 7. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 8. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for dyspnea. 13. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 14. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 15. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for sob, wheeze. 16. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for sob, wheeze. 17. methimazole 10 mg tablet sig: three (3) tablet po daily (daily). 18. morphine 5 mg/ml solution sig: 2 mg iv injection before vac removal/placement (). 19. insulin glargine 100 unit/ml solution sig: 52 units subcutaneous at breakfast. 20. insulin sliding scale-humalog insulin sc sliding scale breakfast lunch dinner bedtime 71-119 10units 6units 9units 0units 120-140 12units 8units 11units 0units 141-199 14units 10units 13units 2units 200-239 16units 12units 15units 4units 240-280 18units 14units 17units 6units > 280 notify md 21. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please check inr twice per week; inr goal 2.0-3.0. 22. outpatient work pt/inr labs twice weekly; please adjust coumadin dose as needed. inr goal 2.0-3.0 weekly cbc/diff, bun/cr, and lft's while on the antibiotics; please have labs faxed id rn's at . discharge disposition: extended care facility: - the elms discharge diagnosis: left lower extremity ischemia left groin lymphatic leak with wound dehiscence discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for a lower extremity bypass operation that included establishing blood flow from your left femoral to right femoral artery and from your left femoral to left popliteal artery followed by an operation to protect your graft after lymphatic leak. you were also being treated with iv antibiotics to treat infection in the wounds. what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions open wound: vac dressing patient's discharge instructions introduction: this will provide helpful information in caring for your wound. if you have any questions or concerns please talk with your doctor or nurse. you have an open wound, as opposed to a closed (sutured or stapled) wound. the skin over the wound is left open so the deep tissues may heal before the skin is allowed to heal. premature closure or healing of the skin can result in infection. your wound was left open to allow new tissue growth within the wound itself. the wound is covered with a vac dressing. this will be changed around every three days. the vac helps keep the wound tissue clean, absorbs drainage, prevents premature healing of skin, and promotes appropriate healing. when to call the doctor: watch for the following signs and symptoms and notify your doctor if these occur: temperature over 101.5 f or chills foul-smelling drainage or fluid from the wound increased redness or swelling of the wound or skin around it increasing tenderness or pain in or around the wound followup instructions: your vascular surgery followup appointment: provider: , md phone: date/time: 2:45 your infectious disease followup appointment: provider: , id west (sb) phone: date/time: 10:50 provider: , md phone: date/time: 10:30 call podiatry for f/u procedure: other revision of vascular procedure enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) other (peripheral) vascular shunt or bypass attachment of pedicle or flap graft to other sites excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other diagnostic procedures on nasal sinuses cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation major depressive affective disorder, single episode, unspecified other complications due to other vascular device, implant, and graft morbid obesity long-term (current) use of anticoagulants infection and inflammatory reaction due to other vascular device, implant, and graft chronic obstructive asthma, unspecified arterial embolism and thrombosis of lower extremity atherosclerosis of native arteries of the extremities with ulceration cellulitis and abscess of foot, except toes ulcer of heel and midfoot pseudomonas infection in conditions classified elsewhere and of unspecified site disruption of external operation (surgical) wound goiter, unspecified acute edema of lung, unspecified other bone involvement in diseases classified elsewhere unspecified osteomyelitis, ankle and foot diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled other noninfectious disorders of lymphatic channels arthropathy associated with neurological disorders other amputation stump complication infection with drug-resistant microorganisms, unspecified, with multiple drug resistance complications affecting other specified body systems, not elsewhere classified amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to