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 / oxycodone attending: chief complaint: transferred from hospital for mrsa bacteremia, septic knee, respiratory failure major surgical or invasive procedure: radial arterial line placement picc placement history of present illness: mr. is a 67 yo man with copd, morbid obesity, osa, h/o coronary artery aneurysm reparin, osteoartritis with recent b total-knee replacements and septic arthritis who is transferred from hospital for further management. mr. was in his usoh until when he underwent his tkr. his post-operative course was complicated by persistant drainage of fluid from his left knee for which he was placed on clindamycin as an outpatient, he then developed c diff colitis. he also developed a stage 4 decubitus ulcer. . he was admitted to an osh on where he was found to have mrsa septic arthritis and c diff colitis. he was documented to be bacteremic with mrsa for much of this time (last blood culture taken on was positive 1/4 bottles). he was treated with vancomycin for the knee infection and underwent removal of his l knee arthroplasy and placement of a tobramycin spacer on (and decubitus ulcer debridement). post-operatively he has had continued spiking fevers to 102 and progressive dyspnea. he has had approximately 40-60 lbs weight-gain since his initial surgery and has been on bumex iv for diuresis . his c diff was initially treated with flagyl but he has had persistantly + stool, so this was changed to vancomycin. he denies abdominal pain but has had increasing abdominal distension. . he has had progressive dyspnea, no orthopnea. it appears that he has been treated for chf exacerbation with iv bumex and was placed on bipap at 26/20. the patient much prefers being on bipap and has been on it for most of the past 2-3 days. . currently he complains of severe fatigue, no appetite, thirst, general malaise. he also endorses back and lle pain. no abdomial pain, nausea, vomiting. within an hour of being at he was febrile to 101.5 with 1/4 blood cultures positive for gpcs past medical history: obesity osa on home bipap h/o rca aneurysm ligation in ; post-op atrial fibrillation. h/o post-operative atrial fibrillation stroke (1.5 yrs ago) with l-sided weakness (now resolved) copd on home inhalers osteoarthritis hypertension social history: married, from nh, lives with wife. retired product manager in a steel manufacturing plant. enjoys playing blues harmonica. former heavy smoker (quit 18 yrs ago). no etoh or drugs. family history: non-contributory physical exam: t 100.7 bp 129-76 hr 114 rr sao2 95% on 4l n/c cvp 3 when upright, 24 when supine general: obese man, uncomfortable, nad heent: mm dry. perrl, eomi cv: tachycardic, unable to auscultate heart sounds. lungs: in moderate distress, using accessory muscles and pursing lips. cta b, poor airmovement. no wheezing, rales, ronchi. abdomen: very distended and tympanic, non-tender, hypoactive bowel sounds. no rebound, guarding, or masses. flexiseal with brown loose stool back: large decubitus ulcer, 3-cm deep area of debridement, scar tissue and scab ontop of granulation tissue. surrounding superficial extremities: l knee wrapped. r knee with sutures, no erythema or drainage. 3+ble edema pertinent results: admission labs: 10:29pm wbc-10.2 rbc-3.53* hgb-10.1* hct-31.5* mcv-89 mch-28.5 mchc-31.9 rdw-16.6* 10:29pm neuts-65 bands-9* lymphs-13* monos-4 eos-4 basos-0 atyps-2* metas-2* myelos-1* 10:29pm plt smr-normal plt count-374 10:29pm glucose-156* urea n-19 creat-1.2 sodium-140 potassium-4.3 chloride-108 total co2-26 anion gap-10 10:29pm calcium-6.7* phosphate-3.0 magnesium-2.1 10:29pm pt-32.2* ptt-35.0 inr(pt)-3.3* . discharge labs: 03:49am blood wbc-8.0 rbc-3.29* hgb-9.0* hct-29.1* mcv-89 mch-27.5 mchc-31.1 rdw-16.8* plt ct-434 03:49am blood pt-27.0* ptt-29.3 inr(pt)-2.7* 03:49am blood glucose-142* urean-40* creat-1.4* na-146* k-4.4 cl-107 hco3-31 angap-12 03:49am blood calcium-8.2* phos-3.3 mg-2.5 08:30am blood alt-17 ast-36 ld(ldh)-341* alkphos-103 amylase-43 totbili-0.3 10:29pm blood probnp-1176* 04:38am blood caltibc-185* vitb12-1808* folate-13.0 ferritn-240 trf-142* 02:33am blood tsh-1.1 05:01am blood crp-27.7* 05:01am blood esr-17* . studies: knee (2 views) bilat right knee: three views of the right knee demonstrate tricompartmental prosthesis in standard position, with no evidence of loosening or hardware failure. corticated osseous density inferolateral to distal femur is likely related to prior injury or surgery. a 6-mm opacity within the knee joint is may potentially represent a foreign body. there is an apparent suprapatellar joint effusion. left knee: hardware has apparently been removed. a large, 13.6 cm x 7.2 cm diameter lobulated opaque structure extends from the distal femoral shaft to the proximal tibia and has likely been surgically placed for the provided history of washout for treatment of septic left knee joint following knee replacement procedure. the tibiofemoral joint space has apparently been obliterated. apparent diffuse soft tissue swelling is present within the left lower extremity based upon increased thickness of the soft tissues compared to the contralateral right extremity. additionally, the cortical margin of the posterior-inferior aspect of the left femur is not well demonstrated. the possibility of osteomyelitis cannot be excluded. direct comparison to previous outside postoperative radiographs would be helpful. alternatively, if clinical suspicion is high, nuclear medicine white blood cell scan or mri could be considered. . us extremity nonvascular findings: small amount of fluid was noted anterior and superior to the patella. no definite fluid collection was noted above the patella to suggest knee joint effusion. moderate amount of edema was noted within the anterior thigh region. . chest (portable ap) impression: 1. limited radiograph due to large body habitus and portable technique. apparent widening of mediastinum which may reflect prominent vascular structures, but standard pa and lateral views are suggested for more complete assessment of this finding as well as a peripheral pleural opacity in the left mid lung, when the patient's condition permits. 2. likely volume overload. 3. bilateral effusions. . chest (portable ap) findings: ap single view obtained with patient in sitting semi-upright position is analyzed in comparison with a similar preceding study of . there is status post sternotomy, and there are at least three small surgical clips identified in the right-sided mediastinum overlying the heart shadow. there is moderate cardiomegaly, and a rather marked widening and elongation of the thoracic aorta is present. this coincides with a congestive vascular pattern and diffuse hazy densities at the lung bases and most likely representing bilateral pleural effusions. there is no evidence of pneumothorax. the technical quality of the portable chest examination suffers from the patient's extreme dimensions (morbid obesity), and discrete local pneumonic infiltrates cannot be identified with certainty. review of the total seven portable chest examinations from through is performed. all these studies suffer from difficulties to penetrate the lungs appropriately. it is noted that a previously present right jugular vein approach central venous line has been removed. also a previously identified right-sided picc line remains in unchanged position. rather prominent distended azygos vein is compatible with hypervolemia as mentioned on previous reports. impression: stable chest findings are seen on technically limited single view exposures of this very obese patient. brief hospital course: assessment and plan: 67 yo man with copd, morbid obesity, osa, osteoartritis with recent b total-knee replacements who is transferred from osh with mrsa septic arthritis s/p removal of hardware in l knee, c. diff colitis, volume overload. . # respiratory failure: this is multifactorial with components of 1) osa on bipap at home, 2) obesity hypoventilation, 3) copd exacerbation (sig. wheezing on exam), 4) volume overload (reported 50 lb weight gain in last month, anasarca on exam), and possible pneumonia (difficult to image due to obesity). patient has been reportedly ruled out for pe at osh and is anticoagulated on coumadin for atrial fibrillation. for his osa, his bipap setting was adjusted to 25/21 with 4 l o2. for copd, he was started on solumedrol on and was gradually tapered; he has two remaining days of prednisone 10 mg daily. he was also started on monteleukast. he is also on standing albuterol/ipratropium nebulizers and home inhalers. for his volume overload, he was aggressively diuresed with lasix. for empiric coverage of pneumonia, he was started on ceftazidime, quickly defervesed, and thus completed a 10-day course prior to discharge. for waxing and mental status and hyercarbia, patient was placed intermittently on bipap. . # l prosthetic knee infection/bactermia with mrsa: orthopaedics was consulted and recommended outpatient follow up with his original orthopedic surgeon. an ultrasound of the left knee did not show any collection amenable to drainage. blood cultures at are all negative/ngtd. he had a tte that did not show vegetations; a tee was not pursued as there was low suspicion for endocarditis and patient would require 6 week course of vancomycin regardless of result. he was continued on vancomycin with a goal trough of 15-25; last day of planned course is . he will follow up with the clinic at as an outpatient. he remains non-weight bearing on his left lower extremity and should wear his knee immobilizer at all times. sutures remain intact and he will need to follow-up with his orthopaedic surgeon at hospital for further care plan. . # c. diff colitis: pt was transferred on vancomycin therapy. pt tested negative for c. diff toxin on admission. he was started on iv flagyl and transitioned to po. his diarrhea had resolved by discharge. he is to continue flagyl to complete an additional two week course following completion of his vancomycin course. . # acute renal failure: this occurred in the setting of diuresis with a una <10, 11 hyaline casts. he is likely intravascularly dry. no urine eos. cr slowy improved to 1.3 by discharge. medications were renally dose (vancomycin). . # delirium: patient's mental status waxed and waned throughout hospital course, likely related to worsening hypercarbia in the setting of copd and osa. sedating medications were avoided. on he was noted to have acute mental status changes in the setting of high-normal pco2; a 25 mcg fentanyl patch that had been placed for pain control was removed, and his mental status quickly improved. . # acute diastolic congestive heart failure/extravascular volume overload: pt has no clinical history of chf and bnp was measured at 1176. on exam, pt does have significant 3rd spacing, likely compounded by hypoalbuminemia. he did not have proteinuria on u/a. patient was 21.5 liters negative for length of stay at . on day of discharge, his lasix dose was reduced from 80 mg to his home dose of 40 mg . he should continue to be diuresed with a goal fluid balance of 1 liter negative for at least the next 7 days. electrolytes should be carefully monitored with diuresis. . # sinus tachycardia: this was initially thought to be due to intravascular depletion as pt c/o thirst and had dry mucous membranes; however, his hr did not respond to ivf boluses. he remained tachycardic throughout his entire hospital course although his heart rate did improve to the low 100-110 range. etiology of his tachycardia is presumed multifactorial. . # atrial fibrillation: pt remained in sinus tachycardia while in house. his coumadin was adjusted to inr goal of ; he is currently on coumadin 3 mg daily (down from home dose of 7 mg daily) due to concurrent abx dose. if patient goes into a. fib with rvr, calcium channel blocker is recommended over beta-blocker due to significant bronchospasm. inr will need to be closely monitored with coumadin dose adjusted during and after completion of antiobiotic course. . # decubitus ulcer, stage 4: this is s/p debridement at hospital and did not appear grossly infected. per report, there was no evidence of osteomyelitis. this was followed by wound care nursing with dressing changes as per detailed discharge instructions. wound was cultured and positive for vre. . # anemia: this is likely combination of blood loss from or procedures and bone marrow suppression from infection. vit b12/folate levels wnl. iron studies were consistent with anemia of chronic disease. hemolysis labs were neg. hct is stable at 29. . # code status: full. . # access: midline(1 lumen), placed by interventional radiology at on . medications on admission: medications on transfer vancomycin 250mg po q6 hrs vancomycin 1.25g iv q18 hrs aztreonam? 2gm iv q? paxil 20mg po daily potassium 20meq po bid coumadin 7mg po daily mvi bentyl prn pain metoprolol 5mg iv prn tylenol 650mg po prn protonix 40mg po bid rifampin 300mg po bid duoneb zinc bumex 2mg iv q 8 . home medications ambien, nystatin, acidophilus, foradil, spireva, zyrec, lasix, micro k, zinc, mvi, celebrex, asmanex, ms contin, tylenol, humibid-la, nexium, lopid, nasonex discharge medications: 1. lasix 40 mg tablet sig: one (1) tablet po twice a day. 2. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed. 3. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 7. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation inhalation q6h (every 6 hours). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime): please give after evening dressing change. 11. megestrol 400 mg/10 ml suspension sig: one (1) po bid (2 times a day): d/c after patient regains appetite and resumes normal caloric intake. 12. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. prednisone 10 mg tablet sig: one (1) tablet po once a day for 2 days. 16. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 17. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 18. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous qachs. 19. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 20. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): continue for two weeks following completion of vancomycin course; end date . 21. coumadin 3 mg tablet sig: one (1) tablet po at bedtime: target inr . 22. vancomycin 500 mg recon soln sig: seven y (750) ml intravenous q 12h (every 12 hours): end date . 23. bipap mask ventilation sig: apply mask at bedtime: settings 25/21. discharge disposition: extended care facility: medical center - discharge diagnosis: mrsa bacteremia septic joint copd hypoxic hypercarbic respiratory failure clostridium difficile colitis delirium stage iv decubitus ulcer chf exacerbation chronic renal insufficiency pneumonia discharge condition: a&ox3, hr 110s, bp 114/70 discharge instructions: you were admitted for a infected left knee with mrsa bacteremia. you were treated with the antibiotic vancomycin. you will need to continue this antibiotic for a total of 6 weeks, ending on . you will also need to follow up with your orthopedic surgeon. . you also had respiratory difficulties while you were hospitalized. this is likely due to a combination of entities. for your sleep apnea, you were continued on your bipap machine at settings of 25/21. for your copd exacerbation, you were started on steroids and you have two additional days remaining in your taper. you also have fluid in your lungs; you have been getting the medication lasix to help you urinate out extra fluids. followup instructions: please keep the following appointments: provider: . blood division of infectious disease phone: date/time: at 11:30 am . please also see your orthopaedic surgeon dr. at hospital within the next two weeks. you will need to contact him regarding plans for suture removal. . you have been referred to see a pulmonologist at who is also a sleep specialist. if possible, please obtain a copy of your prior sleep study and bring this with you to this appointment: dr. phone: date/time: 9:20 . finally, please follow up with your primary care physician . within 1-2 weeks following your discharge from the rehabilitation facility. her clinic number is . md procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) other postoperative infection congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure other specified cardiac dysrhythmias methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site morbid obesity pressure ulcer, lower back acute diastolic heart failure pyogenic arthritis, lower leg 

Answer: The patient is high likely exposed to