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: levofloxacin attending: chief complaint: fevers, hypotension and sepsis major surgical or invasive procedure: central line placement history of present illness: 64 yo m with hx of cad s/p nstemi, severe copd with multiple intubations on chronic steroids, who was recently admitted between and with copd exacerbation as well as asymptomatic bacteruia and pyuria. despite the positive ua, the pt was only treated with one dose of ceftriaxone in the ed. the abx was discontinued on the floor as he had a chronic in-dwelling foley and he was asymptomatic. he now returns with fevers, diarhea, and left lower quadrant abdominal pains since this morning. the pt reports he ate some yellow rice three days ago. since then he has had fevers, chills, with abdominal discomfort similar to gas pain and diaarheea. his stools were described were as black, loose and watery. he reports having 6 bm/day. on occasion, he has some minimal incontinence with his gas. of note, he has also been on iron supplements. in addition, the pt reports he has had burning with urination intermittently. he has an indwelling foley catheter for >6 months which he has changed once/month. the last time the catheter was changed was in . 20s. he reports he has had dark cloudy urine with white chuncky matter in his stream intermittently. the dysuria occurs when the urine flows around the catheter which occurs occasionally. he started taking ciprofloxacin (unknown dose) at one tab once daily on his own from prior prescriptions five days ago with some improvement in his sx. however he is requesting a foley change. . in the ed, the pt was febrile to 100.6, with hr of 94, and bp of 72/37. he was found to have pursed lipped breathing, upper quadrant pain, and guaiac negative. he was given 5l of ns with transient improvement in his sbp. nonetheless, he had a central line placed and started on iv abx (flagyl 500mg, ceftriaxone 1g, and ceftazidime 1g) as well as stress dose steroids (dexamethasone 10mg). he had an elevated wbc to 17.3 as well as an elevated lactate to 3.6 (which decreased to 0.9 after fluid resuscitation) and a positive ua. in addition, he developed chest pain at at which time he was also given 325mg x1, morphine 2mg x1. his bp decreased after the morphine and he was started on levophed. in addition, he received calcium 1g x1, and albuterol x3 and iprotroprium 3 through his ed stay. the pt was transferred to the for presumed sepsis. past medical history: 1. copd on 4 l o2 at home and s/p multiple admissions and intubations for flares-fev1 .47(19%) fev1/fvc 36% on 4l home 02, and bipap qhs. 2. chronic indwelling urethral catheter with hx of vre uti 3. hx of mrsa 4. cad s/p nstemi () with cath normal, tte with preserved biventricular function. 5. steroid induced hyperglycemia 6. hypertension 7. hyperlipidemia 8. chronic low back pain l1-2 laminectomy from accident at work 9. left shoulder pain for several months 10. cataract 11. gerd 12. bph social history: married with six children. lives at home in with wife. retired mechanic. exposed to a lot of spray paint. former smoker. quit 25 years ago. 20 pack year history. occassional etoh quit marijuana 3 years ago. denies iv drug use. activity limited due to prior spine and current shoulder problems. family history: mother with asthma and father with cancer physical exam: vs: 98.6, 96/57, 72, 14, 99% on 4l nc gen: elderly aa male who appears chronically ill in nad. conversing fluently in full sentences. no accessory muscle use. a+o x3 heent: eomi, anicteric, mm dry, op clear cv: distant heard sounds, very difficult to appreciate heart sounds chest: poor air movement with diffuse expiratory wheezing and prolonged expiratory phase. abd: soft, nt, nd, bs+ ext: wwp, no c/c/e. trace peripheral pulses bilaterally pertinent results: reports: ecg : poor baseline, nsr at 90, nml axis, nml intervals, rsr' in v1, v2, v3, 0.5mm st elevation in v3 only. . cxr : copd. linear atelectasis at the right lung base. no focal pneumonia or chf. . abd ct : "1. emphysema. 2. chronic bibasilar opacities, probably scarring. 3. likely left renal cyst. however, an ultrasound would be helpful for further characterization to exclude a mass. 4. small calcific densities, which most likely are layering in the bladder. however, this could be determined more definitively with a bladder ultrasound examination to assess for bladder stones. 5. diverticulosis throughout the . 6. focus of bowel wall thickening in the sigmoid, which may be artifactual. however, the presence of a mass cannot be excluded by this study." . renal u.s. 10:56 am impression: no evidence of hydronephrosis or kidney stones. limited evaluation of the bladder secondary to decompression with foley catheter. multiple smalool sub- centimeter echogenic foci with a long thickened bladder wall. difficult to assess whether these lesions are intraluminal or intramural. if there is further clinical concern, recommend reexamining with full bladder without foley catheter. . labs: . 06:31am blood wbc-13.2* rbc-3.26* hgb-8.3* hct-25.9* mcv-79* mch-25.4* mchc-32.0 rdw-17.3* plt ct-306 07:11am blood wbc-16.7* rbc-3.37* hgb-8.9* hct-27.0* mcv-80* mch-26.4* mchc-32.9 rdw-18.2* plt ct-340 05:04am blood wbc-12.8* rbc-3.45* hgb-8.7* hct-27.0* mcv-78* mch-25.1* mchc-32.1 rdw-16.8* plt ct-285 02:30pm blood wbc-12.6* rbc-3.73* hgb-9.6* hct-30.1* mcv-81* mch-25.7* mchc-31.8 rdw-17.9* plt ct-308 04:20am blood wbc-13.4* rbc-3.75* hgb-9.5* hct-29.7* mcv-79* mch-25.2* mchc-31.9 rdw-16.9* plt ct-336 12:00am blood hct-28.6* 10:00pm blood wbc-17.8* rbc-3.56* hgb-9.4* hct-28.2* mcv-79* mch-26.5* mchc-33.4 rdw-17.8* plt ct-306 05:41pm blood wbc-14.3* rbc-4.55* hgb-11.6* hct-36.5* mcv-80* mch-25.5* mchc-31.8 rdw-17.1* plt ct-375 04:20am blood neuts-94.4* bands-0 lymphs-4.2* monos-1.3* eos-0 baso-0.1 10:00pm blood neuts-92* bands-1 lymphs-3* monos-1* eos-1 baso-0 atyps-1* metas-1* myelos-0 05:41pm blood neuts-82.7* lymphs-10.8* monos-4.6 eos-1.6 baso-0.3 06:31am blood plt ct-306 06:31am blood pt-12.2 ptt-45.0* inr(pt)-1.0 07:11am blood plt ct-340 04:20am blood pt-12.9 ptt-33.2 inr(pt)-1.1 10:00pm blood plt ct-306 05:41pm blood pt-12.6 ptt-29.5 inr(pt)-1.1 06:31am blood glucose-95 urean-18 creat-0.6 na-137 k-4.1 cl-98 hco3-36* angap-7* 07:11am blood glucose-112* urean-17 creat-0.7 na-136 k-4.3 cl-97 hco3-33* angap-10 02:30pm blood glucose-158* urean-13 creat-0.8 na-131* k-4.2 cl-95* hco3-27 angap-13 04:20am blood glucose-161* urean-14 creat-0.7 na-134 k-4.9 cl-100 hco3-31 angap-8 05:41pm blood glucose-134* urean-20 creat-1.1 na-134 k-4.3 cl-94* hco3-32 angap-12 08:00am blood ck(cpk)-40 10:00pm blood ck(cpk)-37* 05:41pm blood alt-22 ast-17 alkphos-72 amylase-114* totbili-0.5 05:41pm blood lipase-30 08:00am blood ck-mb-4 ctropnt-<0.01 10:00pm blood ck-mb-notdone ctropnt-<0.01 06:31am blood calcium-8.2* phos-2.4* mg-2.0 05:04am blood calcium-8.2* phos-2.6* mg-1.8 04:20am blood calcium-7.5* phos-2.7 mg-1.7 05:41pm blood albumin-3.6 10:00pm blood cortsol-1.9* 10:00pm blood crp-49.2* 10:00pm blood holdblu-hold 08:30am blood type- po2-43* pco2-60* ph-7.30* calhco3-31* base xs-1 intubat-not intuba 08:30am blood lactate-0.9 04:40am blood lactate-1.2 02:22am blood lactate-0.9 01:20am blood lactate-0.8 11:59pm blood lactate-0.9 11:20pm blood lactate-0.9 10:09pm blood lactate-0.8 06:15pm blood lactate-3.6* 04:40am blood hgb-9.6* calchct-29 o2 sat-82 08:30am blood freeca-1.11* 05:41pm urine rbc-* wbc-21-50* bacteria-mod yeast-mod epi-0 05:41pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-mod 05:41pm urine color-yellow appear-hazy sp -1.016 . micro: . 5:41 pm urine site: catheter **final report ** urine culture (final ): staph aureus coag +. >100,000 organisms/ml.. sensitivities performed on culture # 201-8797q . enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities performed on culture # 201-8797q . 5:56 am urine **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. interpret results with caution. staph aureus coag +. 10,000-100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. enterococcus sp.. 10,000-100,000 organisms/ml.. yeast. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | enterococcus sp. | | ampicillin------------ =>32 r chloramphenicol------- 8 s gentamicin------------ <=0.5 s levofloxacin---------- =>8 r =>8 r linezolid------------- 2 s nitrofurantoin-------- 32 s 128 r oxacillin------------- =>4 r penicillin------------ =>0.5 r tetracycline---------- <=1 s vancomycin------------ <=1 s =>32 r . blood cultures x 3: no growth . c.diff x 3: negative brief hospital course: 64 year old m with pmh significant for nstemi, copd with multiple past intubations, htn, and hypercholesterolemia admitted with sepsis secondary to uti. pt was admitted to the icu, then subsequently transferred to the floor. . 1. sepsis pt with findings consistent with urosepsis on admission including hypotension, positive ua, and urine cultures which grew out mrsa and vre. he was admitted to the icu and briefly placed on levophed to maintain his bp. he was then weaned off pressors, and did not have further episodes of hypotension. - pt was initially covered broadly with ceftazidime and linezolid for presumed sepsis, but the ceftazidime was d/c'd once urine cultures grew out mrsa and vre. blood cx's were negative during the admission. - pt was on outpatient prednisone for his severe copd so he was started on stress dose steroids in the icu. he received iv hydrocortisone and fludrocort, which was then changed to prednisone 60mg po qd prior to discharge. . 2. pt has severe copd for which he has had multiple hospitalizations and intubations. given his acute infection and possible adrenal insufficiency he was started on stress dose steroids in the icu, then changed to prednisone as stated above. he did not require intubation during this admission. - continued inhalers including fluticasone and salmeterol. - continued prn albuterol and atrovent nebs. - oxygen as needed to maintain sats in the low 90s. continued with bipap at night per home regimen. . 3. cardiac: pt's history is significant for a nsetmi with preserved biventricular function. at home, he is on lipitor, verapamil, and an . his verapamil and were held on admission in the setting of his hypotension, but were then restarted prior to discharge. he was started on a low dose , but this was d/c'd as pt did not have significant coronary disease by prior cath and has iron deficiency anemia. - continued statin. . pt was in nsr during the entire admission. . 4. pt has anemia with a baseline hct in the high 20s to low 30s. this was most likely due to both iron defeciency anemia and anemia of chronic disease. he also had a decrease in his hct in the ed from 36.5 to 28.2 after receiving over 5 l of ns. this was most likely hemodilutional. no signs of hemolysis on labs. pt's last iron studies were in and were consistent with iron defeciency anemia. - continued iron supplementation. - pt did not require transfusions during this admission. - he should have gi f/u for consideration of ca screening . 5. pt's hyperglycemia was thought to be due to his chronic steroid use, and subseqent stress dose steroids during this admission. pt was initially on an insulin drip in the icu for optimal bs control in the setting of sepsis. he was then changed to a riss. - diet was switched to regular today per pt's request prior to discharge. . 6. psych- continued outpatient psych medications including sertraline and lorazepam. . 7. bph- continued on outpatient finasteride. . 8. gu- ct scan obtained on with concern for calcific densities in the bladder and probable left renal cyst, although this was not fully characterized. us confirmed l renal cyst and also showed echogenic foci near the bladder wall, unclear significance of these findings. could consider repeating ultrasound with full bladder and without foley cath for better characterization. . 9. diarrhea: pt had diarrhea for 2 days during the admission, subsequently improved after bowel regimen was d/c'd. - c.dif negative x 1 . 9. fen- regular diet. electrolyte replacement as needed. . 10. proph- sc heparin; ppi. . 11. access- right ij tlc, pulled prior to discharge. . 12. communication: wife (hcp): (home), (cell). . 13. code status: full code medications on admission: 1. fluticasone 110 mcg/actuation two puff inhalation . 2. salmeterol 50 mcg/dose disk inhalation q12h. 3. ipratropium bromide 0.02 % inhalation q4-6h. 4. albuterol sulfate 0.083 % solution sig: q4h as needed. 5. prednisone taper 6. oxygen pt requires 4-5 l oxygen at home via nc. 7. verapamil 240 mg po q24h. 8. lisinopril 5 mg po daily. 9. atorvastatin 10 mg po daily. 10. sertraline 50 mg po daily. 11. finasteride 5 mg po daily. 12. lorazepam 0.5 mg po bid 13. oxycodone-acetaminophen 5-325 mg po q6h as needed for pain. 14. pantoprazole 40 mg po q24h. 15. calcium carbonate 500 mg po tid w/meals 16. cholecalciferol (vitamin d3) 800 unit po daily. 17. ferrous sulfate 325 po daily. 18. docusate sodium 100 mg po bid. 19. senna 8.6 mg po bid. 20. bisacodyl 5 mg po daily as needed. discharge medications: 1. ketoconazole 2 % cream sig: one (1) appl topical (2 times a day). :*1 tube* refills:*1* 2. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days. :*20 tablet(s)* refills:*0* 3. outpatient lab work please have your cbc checked this , . 4. prednisone 10 mg tablet sig: as directed below tablet po once a day: take 60mg daily x 3 days, then 50mg daily x 3 days, then 40mg daily x6 days, then 30mg daily. :*120 tablet(s)* refills:*2* 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. salmeterol 50 mcg/dose disk with device sig: one (1) inh inhalation q12h (every 12 hours). 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 9. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4-6h (every 4 to 6 hours) as needed. 13. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). :*90 tablet, chewable(s)* refills:*2* 14. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). :*60 tablet(s)* refills:*2* 15. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 16. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 17. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. 18. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed. 19. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 20. verapamil 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). 21. erythromycin 5 mg/g ointment sig: one (1) application ophthalmic twice a day: apply os/od. :*1 tube* refills:*2* 22. refresh tears 0.5 % drops sig: one (1) ophthalmic four times a day as needed for eye dryness. :*30 days* refills:*2* discharge disposition: home with service facility: care group discharge diagnosis: primary diagnoss: sepsis secondary to uti secondary diagnes: copd exacerbation cad htn discharge condition: stable. on o2, but without sob. discharge instructions: please seek medical attention immediately if you experience chest pain, shortness of breath, nausea, vomiting, diarrhea, cough, fever, chills, or dizziness. please attend all follow-up appointments. you will need a cbc checked at a lab this , and you should follow-up with your pcp in the next week. followup instructions: please have a cbc drawn on , and follow-up with your pcp in the next week. provider: breathing tests phone: date/time: 10:40 provider: , m.d. phone: date/time: 11:00 provider: , m.d. phone: date/time: 9:45 md procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation replacement of indwelling urinary catheter infusion of vasopressor agent diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use unspecified septicemia severe sepsis obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) septic shock old myocardial infarction diarrhea streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] dehydration chest pain, unspecified cystic kidney disease, unspecified other specified iron deficiency anemias 

Answer: The patient is high likely exposed to