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: ticlid / integrilin / zocor / zetia attending: chief complaint: chf exacerbation, admitted directly from clinic major surgical or invasive procedure: none. history of present illness: mr. is a 71-year-old man with end-stage ischemic cardiomyopathy with class iv symptoms whose functional status has worsened in the past month. he was seen in advanced heart failure clinic 1 week ago by dr. and who felt he was in decompensated systolic heart failure. at that point he complained of worsening dyspnea at rest and daytime somnolence with feeling dizzy after taking his morning blood pressure medications. they recommended he decrease his toprol to 50 mg a day to see if he might feel better with less beta-blockade, to discontinue his imdur if he has substantial headache or feels dizzy and noted that if his symptoms persist, he may need to be admitted at his follow up appointment this week for inotropic-assisted diuresis with the consideration for palliative therapy with home inotropic treatment. they also asked him to discontinue lipitor secondary to muscle cramps. he was seen for follow up in the clinic this morning and reported an 8 lb weight gain over the past week, increasing le edema, dyspnea at rest, persistent orthopnea and difficulty sleeping. he was admitted directly from clinic for diuresis and chf management. ros: in addition to above symptoms + for baseline intermittent non-radiating cp on exertion which resolves with nitro, 2 pillow orthopnea, decreased appetite past 2 months, dizziness with activity, easy fatigueability, mild muscle cramps. negative for cough, abd pain, n/v/d, fever, chills, passed bm q 2 days, no brbpr or hematuria or difficulty urinating. . past medical history: -cad s/p s/p cabg (svg-lad, svg-om, svg-rca), re-do cabg (lima-d1, svg-om, svg-rca), and numeropus angioplasties/stenting procedures to the native arteries as well as the bypass grafts: -recent cath showed all native vessels proximally occluded. the lima to d1 graft is patent with 50% disease after the touchdown, svg to lad graft had 70% lesion treated with a drug-eluting stent, and svg to om1 graft is patent with 90% disease in the av groove circumflex artery. -s/p biventricular aicd placed after vf arrest -thrombus on aicd wire, on coumadin -s/p ventricular tachycardia eblation -chronic systolic and diastolic heart failure: severe lv dysfunction with an ef of 15% renal insufficiency, creat 3.0 pvd s/p external iliac artery stent gastritis hypertension hyperlipidemia bph- no longer on flomax social history: originally from , lives in with his wife. used to work designing signs. smoked 1/2-1 ppd x 50 years, quit in 4/. 1 glass wine with dinner. has son and daughter in the area. family history: father with htn, mi in his 60s, mother with stomach ca, sister with some type of nasal cancer. physical exam: vs - t95.5 bp 112/78 hr 88 rr 20 95% on 3l nc gen: wdwn elderly male in nad but occasionally stops talking to take his breath. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp to angle of jaw cv: rr, normal s1, s2. ?s3. no murmurs appreciated. no thrills, lifts. chest: no chest wall deformities, scoliosis or kyphosis. midline chest scar well healed. resp were slightly labored, no accessory muscle use. decreased bs l>r, crackles at r base, no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: 2+ pitting edema to shins. skin: dried flaky skin on legs, no ulcers, or xanthomas. pertinent results: 07:00pm blood wbc-8.0 rbc-4.15* hgb-11.9* hct-36.7* mcv-89 mch-28.6 mchc-32.4 rdw-16.1* plt ct-243 03:57am blood wbc-19.4* rbc-3.93* hgb-11.4* hct-34.3* mcv-87 mch-29.0 mchc-33.2 rdw-16.6* plt ct-193 07:24am blood wbc-9.6 rbc-3.43* hgb-9.7* hct-29.7* mcv-87 mch-28.2 mchc-32.6 rdw-16.8* plt ct-281 07:00pm blood neuts-84.7* lymphs-6.5* monos-6.0 eos-2.5 baso-0.2 04:58pm blood neuts-93.0* lymphs-3.4* monos-3.2 eos-0.3 baso-0.1 03:59am blood neuts-86.0* lymphs-5.7* monos-7.3 eos-0.9 baso-0 07:00pm blood pt-15.9* ptt-23.5 inr(pt)-1.4* 04:58pm blood pt-26.7* ptt-35.2* inr(pt)-2.7* 07:24am blood pt-28.0* ptt-35.3* inr(pt)-2.8* 07:00pm blood glucose-110* urean-71* creat-2.6* na-131* k-3.7 cl-89* hco3-29 angap-17 04:58pm blood glucose-206* urean-78* creat-3.6* na-119* k-3.8 cl-73* hco3-35* angap-15 07:24am blood glucose-135* urean-97* creat-2.9* na-119* k-5.0 cl-83* hco3-26 angap-15 07:00pm blood calcium-9.1 phos-4.7* mg-2.3 07:24am blood calcium-8.3* phos-4.8* mg-2.7* 03:57am blood tsh-2.3 03:57am blood cortsol-42.3* 03:57am blood osmolal-276 . blood culture blood culture, routine-pending blood culture blood culture, routine-final inpatient ngtd blood culture aerobic bottle-final; anaerobic bottle-final inpatient ngtd blood culture aerobic bottle-final; anaerobic bottle-final inpatient ngtd blood culture aerobic bottle-final; anaerobic bottle-final inpatient ngtd blood culture aerobic bottle-final; anaerobic bottle-final inpatient ngtd blood culture aerobic bottle-final ngtd; anaerobic bottle-final {staph aureus coag +} inpatient blood culture aerobic bottle-final {staph aureus coag +}; anaerobic bottle-final {staph aureus coag +} inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final {staph aureus coag +} inpatient urine urine culture-final inpatient blood culture aerobic bottle-final {staph aureus coag +}; anaerobic bottle-final {staph aureus coag +} inpatient blood culture aerobic bottle-final {staph aureus coag +}; anaerobic bottle-final {staph aureus coag +} 8:14 am blood culture source: line-iv. **final report ** aerobic bottle (final ): staph aureus coag +. sensitivities performed from anaerobic bottle. anaerobic bottle (final ): reported by phone to 6b 21:35 . staph aureus coag +. final sensitivities. 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 ______________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s . ecg study date of 5:28:36 pm ventricular paced rhythm with ventricular premature beats. compared to tracing of no significant change. intervals axes rate pr qrs qt/qtc p qrs t 94 124 158 394/453 44 -111 55 . pa and lateral chest compared to : mild pulmonary edema, progressive pulmonary vascular engorgement, moderate left and small right pleural effusion are all new since . heart size is partially obscured but probably larger as well. transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator leads are unchanged in their respective positions. there is no pneumothorax. . portable upright chest radiograph obtained and compared to prior study. there is marked cardiomegaly. patient is status post median sternotomy. an icd/pacer is present in the left chest wall. three leads terminate within the right atrium and right ventricle. the right lung is clear. the left lung demonstrates a mildly loculated pleural effusion as well as left lower lobe atelectasis versus consolidation. since the prior study, the right lung appears to have cleared. the left lung remains the same. chest (portable ap) in comparison with the study of , the lung volumes have decreased. however, there is little change in the enlargement of the cardiac silhouette with pulmonary vascular congestion. pacemaker device remains in place.impression: little change. 8:03 am chest (portable ap) comparison to . the radiographic appearance is almost unchanged. moderate cardiomegaly, left-sided pacemaker, and right-sided central access. no evidence of cardiac decompensation, suprabasal linear atelectasis, unchanged minimal cardiac effusion. no evidence of pneumonia. impression: unchanged radiograph as compared to . . shoulder views non trauma left port 2:04 pm two views of the left shoulder are obtained. left chest wall pacer/aicd is present. this partially obscures visualization of the left glenoid. there is normal mineralization. there is moderate osteoarthritis of the acromioclavicular joint. the humeral head is high riding, consistent with longstanding rotator cuff tear. there are mild degenerative changes in the glenohumeral joint as well.impression:moderate degenerative changes of the acromioclavicular joint. chronic radiographic findings of longstanding rotator cuff tear. mild degenerative changes of glenohumeral joint. . tte - the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 15-20 %). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. there is mild global right ventricular free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: no valvular vegetations seen. . unilat up ext veins us 11:04 am findings: ultrasound evaluation of the left upper extremity deep venous system using grayscale, color, and pulsed wave doppler reveals the veins to be fully compressible with normal color flow, augmentation, and respiratory variation in flow. impression: no evidence of dvt involving the left upper extremity. brief hospital course: 71 y o m with end-stage ischemic cardiomyopathy with class iv symptoms admitted for diuresis. hospital course by problem: . #. acute on chronic systolic and diastolic heart failure ef 15%: patient has class iv heart failure symptoms. he was diuresed 6 liters on the floor as inpatient but suffered a drop in his sodium in the setting of diuresis with lasix and , he was transferred to the ccu for a trial on milrinone for diuresis. this was ineffective and his sodium continued to drop, renal was consulted who recommended hypertonic saline to correct sodium, with a sodium nadir of 117. hypertonic saline was d/c'd when sodium was 126. he was transferred to a po regimen of lasix 60mg po daily (home dose was 40mg po daily) and home dose of spironolactone. the patient is fluid overloaded but given his end stage heart failure he was unable to be diuresed any further, he has peripheral edema and pulmonary edema- his lue has worse edema but there is no upper extremity dvt on ultrasound. patient should not receive in the future, but can receive lasix. the patient has a very poor prognosis and this was explained to him. after repeated discussions the patient decided to turn off his icd functioning and in a family meeting it was determined he would be dnr/dni. the goals of care were determined to be for him to return home with hospice care with the goal of making him comfortable. he was transferred back to the cardiology floors where he was continued on lasix 60mg and spironolactone and he was kept comfortable on 2-3l o2. no further labs are to be drawn. . #. hyponatremia- he had a low baseline na due to end stage chf but this became more profound with diuresis. he was given hypertonic saline, which improved the sodium only transiently. diuresis was limited by hyponatremia and renal failure and repletion of na was limited by his heart failure. renal was consulted and agreed with above. he was initially severely fluid restricted to 1l, but given his request to drink and the goal shifting to comfort this restriction was loosened to 1.5l daily. . #. bacteremia: 4/4 bottles from , and from had mrsa in blood. no positive cultures from thru . unclear source for infection, possibly an infiltrated iv site in his hand, but given pacer/indwelling hardware, we chose to aggressively treat. tte did not show evidence of vegitation and a tee was deferred. id was consulted, iv vancomycin was started on and a picc was placed on . the plan is to continue the patient on vancomycin for a 6 week course for palliation. #. coronary artery disease: he was continued on his outpatient regimen of aspirin, plavix, statin, imdur 30mg daily, hydralazine 50mg po q6hrs. lopressor 50mg po bid. on discharge his statin was discontinued given this is for long-term prevention and his prognosis was poor. . #rhythm: biventricularly paced, tachycardia and ectopy mildly improved since admission, though frequent pvcs. s/p vt ablation in . apparently has been intermittently on amiodarone after his vfib arrest in . he was continued on metoprolol 50 mg po bid and coumadin 2mg daily. #. history of icd wire thrombus. goal inr , he was anticoagulated with coumadin. he was kept on his outpatient regimen of 2mg daily coumadin. no further labs are to be drawn. . #. acute on chronic renal insufficiency, baseline cr ~2.6. his cr improved initially with diuresis likely from improved forward flow, but then bumped as diuresis was limited as explained above . #. gastritis- he was continued on ranitidine and ppi . #anemia: normocytic. iron-deficient in and currently on iron supplementation. likely also from renal disease. hct was stable. he was continued iron replacement though this was discontinued to simplify his home regimen. . #. pt did not complain of symptoms, currently not on any meds for this. . #. le muscle cramping- pt cramps improved w/flexeril but returns occasionally. be secondary to hypokalemia. pain was also managed with oxycodone. #. code status: dnr/dni communication: patient and hcp wife (h); (o); ( (c) dispo: home with hospice care . medications on admission: 1. aspirin 325 mg tablet, delayed release (e.c.) po daily 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily 3. nitroglycerin 0.3 mg tablet, sublingual sig: as needed for chest pain. 4. isosorbide mononitrate 60 mg tablet sustained release 24 hr po daily 5. docusate sodium 100 mg po bid 6. hexavitamin one (1) cap po daily 7. ferrous sulfate 325 (65) mg tablet po daily 8. folic acid 1 mg (1) tablet po daily 9. atorvastatin 40 mg (1) tablet po daily (changed last week from 80) 10. toprol xl 50 mg po daily (changed last week from 100) 11. prilosec 40 mg capsule, delayed release(e.c.)po daily 12. ranitidine hcl 150 mg tablet (1) tablet po hs 13. warfarin 4 mg po daily (daily)--->confirm 14. fish oil 1,000 mg po daily 15. spironolacton-hydrochlorothiaz 25-25 mg, 0.5 tablet po daily 16. furosemide 40 mg po daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gm intravenous q 24h (every 24 hours) for 33 days: start date , 6 week course. disp:*33 gm* refills:*0* 3. heparin flush heparin flush per protocol of neht 4. normal saline flush normal saline flush per protocol of neht 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. cyclobenzaprine 10 mg tablet sig: 0.5 tablet po bid (2 times a day) as needed for muscle cramps. disp:*30 tablet(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100 hr<55. disp:*60 tablet(s)* refills:*2* 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 11. methyl salicylate-menthol 15-15 % ointment sig: one (1) appl topical tid (3 times a day) as needed. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 13. hydralazine 25 mg tablet sig: two (2) tablet po q6h (every 6 hours): hold for sbp<100. disp:*240 tablet(s)* refills:*2* 14. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 15. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 16. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). disp:*60 tablet sustained release 12 hr(s)* refills:*0* 17. warfarin 2 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 18. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 19. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: home therapies discharge diagnosis: primary: end stage acute on chronic systolic heart failure methicillin-resistant staph aureus bacteremia secondary: acute on chronic renal failure peripheral vascular disease status post external iliac artery stent gastritis hypertension hyperlipidemia status post biventricular pacemaker and aicd placement history of thrombus on aicd wire discharge condition: home with hospice care, afebrile, breathing comfortably on 3l o2. discharge instructions: you were admitted to the hospital for severe heart failure. we gave you diuretics and tried to optimize your medical management but were limited by your low sodium levels and worsening kidney function. in addition, you developed a blood infection for which we have given you iv antibiotics. after discussions with you and your family it was determined that you would go home with hospice care and your defibrillator was turned off. . please take your medications as prescribed. please go to your follow up appointments. . if you develop chest pain, difficulty breathing, or any other concerning symptoms, please contact your hospice care provider or physician. followup instructions: infectious disease provider: ,md mph: date/time: 11:00 . cardiologist: dr. phone: date/time: 10:30 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: end stage renal disease congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia infection with microorganisms resistant to penicillins aortocoronary bypass status personal history of tobacco use hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified forms of chronic ischemic heart disease bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of anticoagulants iron deficiency anemia, unspecified automatic implantable cardiac defibrillator in situ cardiac pacemaker in situ atherosclerosis of native arteries of the extremities, unspecified acute on chronic combined systolic and diastolic heart failure other specified gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to