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: gastrointestinal bleed major surgical or invasive procedure: right internal jugular central line placement and removal history of present illness: mr. is a 66 year old man with dm, cad, s/p recent stemi, ischemic cardiomyopathy levf 25%, errosive gastritis, and colon polyps who is admitted from rehabilitation for 1 week of black stool, and a slow hct drop. according to the report hct trend: 30 () -> 27 ()->22 today and he was transferred to the emergency department. . in the ed, initial vs were: t: not recorded, p:92 bp:120/69 rr:28 sa02:100% fio2: 40%. he subsequently spiked to t:102.6. labs were remarkable for hct 20.9, wbc 6.7 83.2% lactate 2.4, cr 1.5, ua positive. patient was given vanc/zosyn, pantoprazole drip and 80mg bolus, and a rij was placed, gi was consulted who recommended non-urgent scope, and to continue pantoprazole 40mg iv bid vs drip. not transfused in the ed. vs prior to transfer: t99.8 hr 84 122/67 22 on vent 100% ac 450x12 peep 5 fi02 50% . on arrival to the icu, t:99.9 bp: p:84 r: 18 o2:100% ac 450x12 50% fio2. he reported that his breathing is comfortable, denies chest pain. he complained of pain at the site of his saccral decubitis. . review of sytems: (+) per hpi (-) denies fever, chills. denied shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting. . of note patient was hospitalized recently in the micu . he was admitted for stemi, urosepsis and hypotension. stemi was medically managed with heparin, plavix, asa, statin, echo showed newly depressed ef to 25% with wide lv hypokinesis. he grew vre from blood and urine and was treated with daptomycin, meropenem and linezolid. he was intubated for increased work of breathing and treated for heart failure and vap however the micu team was unable wean him off of the vent, he is s/p trach and peg. hospital course was also complicated by pulseless vt x4 managed with synchronized cardioversion and amiodarone. goals of care at end of hospital course were dnr, do not escalate care past medical history: ventilator dependent last vent settings psv 12/5 atc 40% fio2 coronary artery disease c/b stemi medically managed ventricular tachycardia s/p cardioversion ischemic cardiomyopathy lvef 25% erosive esophagitis c/b recurrent gi bleeds bilateral cea diabetes mellitus sacral decubitis bl heel pressure ulcers chronic kidney disease baseline creatinine 1.4-1.6 pvd: mild-moderate aorto--ilac disease as noted in gerd colonic polyps vre uti mrsa pneuomonia hyperlipidemia macular degeneration chronic back/leg pain secondary to djd essential tremor peripheral neuropathy s/p left and right total hip replacements copd depression social history: denies current tobacco use (h/o 20+ pack year, quit 15-20 years ago) admits to approximately 2+ beers most nights of the week. denies h/o illicit drug use. resident at health. family history: non-contributory physical exam: admission examination vitals: t:99.9 bp: p:84 r: 18 o2:100% ac 450x12 50% fio2 cvp:16 general: alert; follows simple commands heent: tracheostomy in place on ventilator tube in place; mmm, perrl neck: supple, jvp elevated at 10cm, right ij catheter in place lungs: left basilar rales, otherwise clear to auscultation in posterior lung fields. cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly back: deep sacral decubitis ulcer with packing in place gu: foley in place ext: right lower ext cool to touch, left warm to the touch. radial pulses 1+ bl. bilateral r>l heel ulceration with granular base and eschar; no exudates/purulence visible; 1+ pedal edema pulses: right pt palpated, dp not dopplerable left pt and dp dopplerable discharge exam: t96.2, hr66 bp135/69, rr21, 100% on pressure support 8cm/5cm, rr20,fi02 40% general: alert; follows simple commands heent: tracheostomy in place on ventilator tube in place; mmm, perrl neck: supple, right ij catheter in place lungs: bibasilar rales on anterior/lateral auscultation cv: rrr, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: cool, 1+ radial pulses, bandages over heels b/l, trace pedal edema pertinent results: admission labs: 06:45pm blood wbc-6.7 rbc-2.17* hgb-6.9* hct-20.9* mcv-96 mch-31.7 mchc-33.0 rdw-17.9* plt ct-157# 06:45pm blood neuts-83.2* lymphs-11.4* monos-4.3 eos-0.7 baso-0.5 06:45pm blood pt-14.3* ptt-37.1* inr(pt)-1.2* 06:45pm blood glucose-155* urean-82* creat-1.5* na-147* k-3.8 cl-99 hco3-36* angap-16 06:45pm blood alt-96* ast-73* ld(ldh)-249 ck(cpk)-22* alkphos-125 totbili-0.4 06:45pm blood calcium-8.3* phos-5.3*# mg-2.7* 06:45pm blood hapto-380* 07:08pm blood lactate-2.4* cardiac enzymes 06:45pm blood ck-mb-1 ctropnt-0.49* . discharge labs: 03:17am blood wbc-8.5 rbc-3.36* hgb-11.2* hct-32.3* mcv-96 mch-33.2*# mchc-34.6# rdw-17.8* plt ct-175 03:17am blood plt ct-175 03:17am blood pt-14.3* ptt-38.7* inr(pt)-1.2* 03:17am blood glucose-74 urean-66* creat-1.6* na-148* k-3.3 cl-104 hco3-31 angap-16 03:17am blood calcium-8.0* phos-4.3 mg-2.3 04:29am blood lactate-1.1 . imaging: cxr 1. interval placement of right internal jugular central venous catheter terminating in the proximal to mid svc, without evidence of pneumothorax. 2. bilateral layering pleural effusions, increased, with overlying atelectasis, underlying consolidation not excluded. additional peripheral right upper lobe patchy opacity may be due to additional site of infection and/or aspiration. pulmonary edema. cardiomegaly. . tte the left atrium is mildly dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (lvef= 25-30 %) secondary to akinesis of the inferior and posterior walls, and hypokinesis of the interventricular septum. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. severe (4+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , there has been marked progression of mitral and tricuspid regurgitation (both of the functional ischemic classification) consistent with the natural history of this patient's recently documented untreated extensive inferior posterior and right ventricular myocardial infarction. brief hospital course: hospital course 66yo chronically-ventilated m pmh recent stemi, ischemic cardiomyopathy levf 25%, errosive gastritis, a/w slow upper gastrointestinal bleed and pna, bleeding stabilized without surgical/endoscopic intervention, started on high-dose cefepime for mdr psuedomonal pna, clinical status improving with patient discharged to ecf. . active # gi bleed: patient w h/o errosive gastritis on egd , who presented w downtrending hct (30 to 20.9), guaiac + stool. patient received 3 units prbcs w stabilization of hct in low 30s. patient was continued on iv ppi and started on carafate. hct stabilized (>48 hours) without invasive intervention and gi service opted not to scope. . # respiratory failure pna and chronic systolic chf: ventilator dependent patient mrsa pneumonia and heart failure, with pulmonary infiltrates on admission. sputum grew out psuedomonas with sensitivities demonstrating carbapenem resistance. per id recommendations, patient was started on high dose extended infusion cefepime. id fellow agreed to follow up further micro data on patient. he was continued on home lasix, nebulizers. . # coronary artery disease c/b ischemic cardiomyopathy: patient with recent stemi that was medically managed (given his prior bleeds) with asa, plavix, and a statin, who was w/o signs ischemia on admission, but w signs c/w worsening failure. given some hypotension on admission, metoprolol dosing was decreased. tte demonstrated lvef 25%, 4+mr. cardiology was consulted, who recommended started ace-i. if he remained stable, they also recommended starting spironolactone (not started at discharge, recommended to start at ecf). . inactive # h/o vt: patient was continued on amiodarone. . # dm: patient was continued on standing glargine and sliding scale insulin . # thrombocytopenia: patient continued to have thrombocytopenia on this admission. heparin antibody was negative in prior admission. on discharge platelets 175. . # sacral decubitis: patient with deep sacral decubitis, bilateral heel ulcers. followed by wound care during inpatient stay. should be followed at rehab center. . transitional 1. code status: patient remained dnr for duration of hospital stay 2. pending: at time of discharge, additional sensitivities for psuedomonas (doripenem and colistin) were pending. id fellow would follow-up. 3. transition of care: patient discharged to , with follow-up planned with heart failure clinic. 4. barriers to care: recurrent gi bleeds have had major effect on patient management (rehospitalizations, inability to manage stemi w cath), and may necessitate recurrent transfusions or future readmissions medications on admission: acetaminophen 650 mg/20.3 ml oral soln q6h prn albuterol sulfate hfa 90 mcg 6 puffs q6-8 hrs prn amiodarone 400 mg daily ascorbic acid 500 mg daily atorvastatin 80 mg daily chlorhexedine 0.12% 12ml q12h diphenhydramine 25mg q4h prn itching diphenhydramine cream 1appl q8h prn docusate 100mg glucerna 1.2 tube feed 75ml/h furosemide 80 mg iv bid collnaagese clostridium histolyticum 250 unit/g ointment topical insulin glargine 14 qhs insulin regular sliding scale ipratropium/albuterol 3ml q2h prn lorazepam 1mg q8h prn metoprolol tartrate 75 mg q8h pantoprazole 40 mg iv bid sucralfate 1 gram 4x daily polyethylene glycol 17g daily free water 200cc q6h discharge medications: 1. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 2. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain. 3. ascorbic acid 500 mg tablet sig: one (1) tablet po once a day. 4. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 5. pantoprazole 40 mg iv q12h 6. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane tid (3 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 8. cefepime 2 gram recon soln sig: two (2) grams injection q12h (every 12 hours): to be infused over 3 hours. 9. furosemide 80 mg iv bid hold for sbp<90; please contact md if going to hold. 10. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) inhalation q2h as needed for shortness of breath or wheezing. 11. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. 12. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 13. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). tablet(s) 14. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 15. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 16. insulin glargine 100 unit/ml solution sig: fourteen (14) units subcutaneous at bedtime. 17. sliding scale regular insulin sliding scale discharge disposition: extended care facility: - discharge diagnosis: primary hospital acquired pneumonia secondary gi bleed discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: mr. , it was a pleasure taking care of you at . you were admitted with decreasing blood levels, likely due to bleeding from your gastrointestinal tract. you were transfused with red blood cells. your blood levels returned to levels, and remained stable for 3 days. we discussed your care with gastroenterologists who felt that you did not need to have an endoscopy as long as your blood levels remained stable. given your recent history of a heart attack and heart failure, we discussed your case with cardiologists, who felt that certain medications should be started to help your heart function. you were found to have a pneumonia with a very resistant bacteria called psuedomonas. you were seen by infectious disease doctors, who started you on a strong antibiotic called cefepime that you will need to continue for 2 weeks. during the course of this hospitalization, the following changes were made to your medications: -decreased metoprolol to 50mg -started cefepime (to be continued for 13 days) -started captopril -started aspirin -started sucralfate followup instructions: name: , np location: division of cardiology address: , e/rw-453, , phone: we are working on a follow up appointment with np within 1-2 weeks. you will be called with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atherosclerosis of aorta hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified hypopotassemia chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute and chronic respiratory failure long-term (current) use of insulin macular degeneration (senile), unspecified pressure ulcer, lower back do not resuscitate status pressure ulcer, heel hyperosmolality and/or hypernatremia ventilator associated pneumonia unspecified hereditary and idiopathic peripheral neuropathy acute on chronic systolic heart failure pressure ulcer, ankle gastrostomy status pressure ulcer, stage iv pseudomonas infection in conditions classified elsewhere and of unspecified site tracheostomy status other esophagitis mixed acid-base balance disorder dependence on respirator, status acute myocardial infarction of other inferior wall, subsequent episode of care spondylosis of unspecified site, without mention of myelopathy personal history of methicillin resistant staphylococcus aureus atherosclerosis of other specified arteries essential and other specified forms of tremor 

Answer: The patient is high likely exposed to