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: fentanyl attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 27year old male with hajdu- syndrome, (bone disorder) with restrictive lung disease from severe scoliosis and copd (current smoker) at home on 4l o2 by nasal cannula and then simv by ventilator at night presenting to ed with increased sob x 2days and increasing secretions. patient was recently admitted to with right olecranon osteomyelitis. he has been treated for 1.5 weeks with vancomycin for this infection. since then he reports very little improvement in the infection. patient has history of ventilator-associated pneumonia with resistant pseudomonas in recent cultures (sensitive only to tobramycin but treated with cefepime with good result) and reports that over the last few days he has had increasing sob worse than baseline. in addition he has had increasing secretions. he thinks he may also have been having fevers (low-grade). no sick contacts but says this feels like his prior pnas so he came to ed. . vs on arrival to the ed: t:98.9 hr:122 bp:109/79 rr:22 o2sat:98 on 5l trach mask. reportedly received cefepime and/or levoquin in the ed for history of pseudomonal vap since already on vancomycin for osteomyelitis was covered for mrsa. also takes prednisone at home and got 60mg in the ed for ?copd exacerbation. . vs prior to transfer: t 99 hr 108 bp 124/72 rr 20 o2 97% on 5l trach mask. . on the floor, patient complained of sob and requested nebulizer treatments. he denied chest pain, dysuria, n/v/abdominal pain/diarrhea. past medical history: 1. hajdu- syndrome 2. osteomyelitis, right olecranon (pressure-related) 3. chronic obstructive/restrictive lung disease 4. h/o multiple pneumonias, including pseudomonas pna and vap social history: lives at home with his grandparents and brother. a home health aide. - tobacco: active tobacco use ( cigarettes a day) - alcohol: denies - illicits: denies family history: mother and brother with syndrome. physical exam: vitals: t: 98.2 bp: 135/92 p:108 r: 24 o2: 99% on 40% trach mask general: alert, oriented, no acute distress, small stature with marked abnormalities of extremities and back. heent: sclera anicteric, dry mm, oropharynx clear, trach in place without erythema around site neck: supple, jvp not elevated lungs: rales right middle lobe but left side clear. no wheezing. tachypneic but not in acute distress. cv: tachycardic and regular normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, edema pertinent results: 01:09pm lactate-0.9 02:25pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-7.0 leuk-neg 01:00pm wbc-9.3 rbc-3.85* hgb-10.2* hct-31.7* mcv-83 mch-26.5* mchc-32.1 rdw-13.9 01:00pm glucose-128* urea n-17 creat-0.4* sodium-138 potassium-4.0 chloride-96 total co2-34* anion gap-12 01:00pm neuts-94.8* lymphs-4.1* monos-0.7* eos-0.3 basos-0.1 micro: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): moderate growth commensal respiratory flora. pseudomonas aeruginosa. moderate growth. predominating organism. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- =>64 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem------------- 8 i piperacillin/tazo----- =>128 r tobramycin------------ 2 s . images: cxr (wet read): limited study secondar to pt body habitus/scoliosis; rml consolidation - may represent aspiration vs pna . ekg: sinus tachycardia with <1mm ste i avl slightly worse than prior and twi iii. brief hospital course: # respiratory distress/sob: afebrile, no leukocytosis and no evidence of pneumonia on chest xray (although exam difficult due to patient anatomy.) initially started on cipro, cefepime for history of pseudomonas pneumonia. continued on vanco for osotemyelitis and home vent settings for night/day. no microbiologic evidence of bacteria from sputum, legionella antigen negative. thought likely secondary to enterococcus bacteremia, and cipro, cefepime were discontinued. patient's symptoms subjectively improved. # r olecranon osteomyelitis: increased vancomycin dose initially due to low trough, then switched to daptomycin after consultation with id as clinically no improvement. presumably no response to vancomycin. # enterococcal bacteremia: initial blood cultures grew enterococcus and coag neg staph. patient was continued on daptomycin and after extensive discussion with id the decision was made to continue antibiotic treatment via his picc. the risks of removing the picc were high as the patient has difficult iv access and requires a long course of iv antibiotics. the patient will follow up with id on an outpatient basis (as he was doing prior to admission for his osteomyelitis.) # chronic obstructive/restrictive pulmonary disease: continued on home dose of prednisone 15mg daily and bactrim prophylaxis with prn nebs and chest pt. home regimen of trach mask collar and simv at night was continued. # hajdu- syndrome: home pain medications were continued including methadone, morphine, baclofen, gabapentin, and ibuprofen (with holding parameters for somnolence). bowel regimen prn constipation. medications on admission: msir 60mg qid methadone 40mg tid baclofen 40mgs qam, 20mg at 11am 20mg at 7pm gabapentin 800mg tid motrin 800mg tid with food lorazepam 1mg hs singulair daily omprazole daily prednisone 15mg daily (given 60mg in ed) atrovent neb q4h prn albuterol q4h prn pulmicort neb patient also was supposed to have been taking bactrim ds daily for pcp prophylaxis as he is on chronic daily prednisone; however this was not on his home medication list. discharge medications: 1. saline flush 0.9 % syringe sig: one (1) flush injection once a day. disp:*1 month's supply* refills:*2* 2. outpatient lab work please check cbc/diff, bun/cr, esr, crp, ck and fax to dr. 3. daptomycin 500 mg recon soln sig: one (1) vial intravenous once a day: give at 5pm. disp:*1 month's supply* refills:*2* 4. morphine 30 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 5. methadone 10 mg tablet sig: four (4) tablet po tid (3 times a day). 6. baclofen 10 mg tablet sig: four (4) tablet po qam (once a day (in the morning)). 7. baclofen 10 mg tablet sig: two (2) tablet po twice daily at 11am and 7pm (). 8. gabapentin 400 mg capsule sig: two (2) capsule po q8h (every 8 hours). 9. ibuprofen 400 mg tablet sig: two (2) tablet po q8h (every 8 hours): with food. 10. lorazepam 1 mg tablet sig: one (1) tablet po q 24h (every 24 hours). 11. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 13. testosterone 5 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal q24h (every 24 hours). 14. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po q12h (every 12 hours). disp:*60 tablet, chewable(s)* refills:*2* 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 17. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 18. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 19. prednisone 5 mg tablet sig: three (3) tablet po daily (daily). 20. budesonide 1 mg/2 ml suspension for nebulization sig: one (1) neb inhalation twice a day. 21. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*14 capsule, delayed release(e.c.)(s)* refills:*0* 22. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po once a day. disp:*14 tablet sustained release(s)* refills:*0* 23. bactrim ds q day discharge disposition: home with service facility: discharge diagnosis: enterococcal bacteremia 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: you were admitted to the hospital with difficulty breathing. we think this was because your infection in the arm was not treated enough and you felt sicker than usual which made you too weak to cough well. your antibiotics were switched to daptomycin (from vancomycin). we left in your picc line because it was very difficult to place and putting in a new one would be riskier than treating your infection through the line. you should continue to follow along with your infectious disease doctor as you were. followup instructions: provider: , md phone: date/time: 9:50 provider: , md phone: date/time: 10:00 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: tobacco use disorder obstructive chronic bronchitis with (acute) exacerbation sepsis acute and chronic respiratory failure other diseases of lung, not elsewhere classified streptococcal septicemia pressure ulcer, elbow pressure ulcer, stage iv tracheostomy status thoracogenic scoliosis other specified anomalies of muscle, tendon, fascia, and connective tissue carrier or suspected carrier of other specified infectious organism chronic osteomyelitis, forearm 

Answer: The patient is high likely exposed to