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: adhesive tape attending: chief complaint: altered mental status, hypotension, hypoxia. major surgical or invasive procedure: ct-guided drainage of left gluteal abscess (). history of present illness: mrs. is a 72 y/o woman with pmh notable for paraplegia anterior spinal artery infarct, indwelling suprapubic catheter with frequent utis admitted with altered mental status and hypoxia. per nursing facility notes, the patient was noted to be unresponsive to voice commands but responsive to tactile stimuli. vitals at the time were bp 100/50, hr 100, rr 20, o2 80% on ra which increased to 97% on 6 l nc. reportedly, she is alert & oriented x 3 at her baseline. of note, she is currently on nitrofurantoin 100 mg po bid for a uti (? culture result) which she started on for a planned 10 day course. she apparently also complained of nausea and may have vomited so lactulose was held today. . on arrival to the ed, initial vitals were t 102.1, hr 100, bp 132/56, rr 24, 97% on 15 l via nasal cannula. blood pressure trended down to 80s systolic. she was originally on peripheral dopamine for bp improvement but as this was not effective, it was changed to peripheral levophed with subsequent improvement in blood pressures to 120s systolic. blood and urine cultures were sent. she was treated with pr tylenol, levofloxacin 750 mg iv x 1, vancomycin 1 g iv x 1, and 1 g ceftriaxone x 1. she received a total of 6 l ns in the ed. . on arrival to the micu, the patient denies any pain. she is alert and speaking a few words at a time though they are difficult to interpret. she specifically denies any shortness of breath or any abdominal pain. past medical history: past medical history: (from omr) - paraplegia anterior spinal infarct () - thoracic aneurysm repair () - copd (? on home o2). with history of lll collapse/pna s/p mucous plug removal via bronchoscopy. - htn - hyperlipidemia - gerd - suprapubic catheter placement / utis on ppx bactrim - fecal incontinence - depression - atraumatic comminuted l intertrochanteric femur fracture - chronic sacral decubitus ulcers with past bilateral ischial tuberosity osteomyelitis social history: the patient admits 2-3ppd x 40+ years, but has smoked intermittently for the past five years. the patient denies alcohol or illicit drug use. her son, , is listed as her hcp (); however, he tells me that she "has made it clear she wants nothing to do with him" and he defers to his other brother , . family history: son has dm. physical exam: vs t 101.3, hr 84, bp 153/42, rr 23, o2 97% on 4l nc gen: obese elderly woman lying in bed, eyes open, no acute distress heent: perrl, eomi, op clear, mmm neck: no jvd, no lymphadenopathy, no meningismus cv: rrr, no appreciable murmur chest: grossly clear with occasional expiratory wheezing abd: obese, distended but soft, normoactive bowel sounds, no tenderness to palpation; suprapubic catheter in place with dressing; + erythematous yeast infection inferior to both breasts and in groin around to back ext: upper extremities with > tone than lower extremities, bilateral lower ext in multipodus boots, no peripheral edema back: sacral ulcer which probes to bone, some thick tan discharge in wound but tissue appears beefy red; bilateral ischial ulcers 2 cm in size neuro: face symmetric, cn ii-xii grossly intact, bilateral hand grip , shoulder shrug symmetric bilaterally, does not move either leg, dtrs not elicited at bilateral biceps, patellae; speaking short sentences & seems to appropriately answer yes/no questions; denies any pain; toes mute bilaterally; upper extremities stiff. pertinent results: labs at admission 11:00am blood wbc-16.7*# rbc-4.56 hgb-12.1 hct-36.8 mcv-81* mch-26.6* mchc-32.9 rdw-17.6* plt ct-416 11:00am blood neuts-88.5* lymphs-7.6* monos-3.1 eos-0.3 baso-0.4 07:37pm blood pt-17.8* ptt-25.6 inr(pt)-1.6* 11:00am blood glucose-141* urean-9 creat-0.5 na-145 k-2.8* cl-104 hco3-29 angap-15 07:37pm blood albumin-2.4* calcium-6.6* phos-1.4*# mg-1.7 . culture data . abscess gram stain-final; wound culture-final {staph aureus coag +}; anaerobic culture-preliminary inpatient blood culture negative blood culture negative blood culture negative blood culture negative blood culture negative blood culture negative blood culture negative blood culture negative blood culture mrsa blood culture negative blood culture negative blood culture negative blood culture mrsa urine culture yeast blood culture negative blood culture negative blood culture negative blood culture negative urine culture yeast blood culture mrsa . studies . chest x-ray () there is bilateral atelectasis. there is no evidence of focal consolidation that would be indicative of pneumonia. there is no evidence of congestive heart failure. the mediastinal and cardiac contours are stable. there is again evidence of post-surgical changes. there is no pleural effusion and no evidence of pneumothorax. the visualized osseous structures are stable. impression: no evidence of pneumonia. . transthoracic echocardiogram () the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. compared with the prior study (images reviewed) of , the findings are similar. . ct head without contrast () 1. no evidence of acute intracranial abnormalities. 2. fluid in the right maxillary sinus, which may indicate acute sinusitis. . mr pelvis () impression: 1. large sacral/coccygeal decubitus ulcer extending up to the inferior sacrum. abnormal signal involves both sides of the inferior sacrum, likely from a combination of osteomyelitis. te possibility of a superimposed nondisplaced left sacral alar insufficiency fracture cannot be excluded. 2. 2.6- cm rim-enhancing high t2 structure in the left gluteal soft tissues lateral to and apparently communicating with the ulcer tract -- ? abcess collection vs packing material in recess of ulcer. please see comment above. 3. stable appearance of the ulcer tracts extending up to the ischial tuberosities bilaterally with abnormal signal and enhancement about the posterior aspect of the ischial tuberosities, consistent with osteomyelitis. 4. old left intertrochanteric fracture only partially imaged on today's study. 5. prominent sacral tarlov's cysts. 6. suprapubic catheter seen approaching the bladder; it is difficult on the images performed today to determine if the balloon and tip are in fact within the bladder lumen. clinical correlation is therefore requested -- is this tube draining urine?. 7. distended large bowel most consistent with ileus. . mr brain () 1. unchanged bilateral white matter foci of hyperintensities on t2-weighted and flair images may correspond to chronic microvascular ischemia. 2. no evidence of acute infarction, masses, or other lesions. 3. limited mra evaluation of the brain due to a significant image degradation from motion artifact demonstrates no identifiable stenosis, occlusion, aneurysm in the visualized vessels. the mcas and the left vertebral artery are poorly visualized. . eeg () impression: this is a normal routine eeg in the waking and drowsy states. there is no evidence of focal slowing or epileptiform discharges. . ct-guided drainage of left gluteal abscess () 1. successful ct-guided aspiration of approximately 1 cc of bloody pus from the left parasacral/left gluteal collection. 2. sclerosis of both ischial tuberosities, highly suggestive of osteomyelitis. 3. persistent left intertrochanteric fracture. . chest x-ray pa and lateral () there are multiple healed rib fractures from prior thoracotomy on the left, with residual osseous deformity. right picc terminates in the superior vena cava. there is bibasilar atelectasis. impression: no appreciable change from the prior study. brief hospital course: a 72 year-old woman with past medical history notable for paraplegia secondary to spinal artery infarct, copd, and indwelling suprapubic catheter admitted with mental status change, fever, and leukocytosis. . 1. septic shock. she presented with low blood pressure, elevated white count, fever, and mental status change. she was bolused with 6l normal saline in the ed and started on dopamine. when she arrived to the icu levophed was running peripherally with systolic blood pressures in the 130s. this was quickly weaned off and her systolic bp stablized in the 90-110s. overnight, she was started on vancomycin and cefepime for empiric coverage of sepsis from uti versus other source, such as large stage iv sacral decubitus ulcer. a blood culture from this first hospital day later grew out methicillin resistent staph aureus. a urine culture grew out but no significant bacteria. thus the vancomycin was continued and cefepime discontinued on hospital day 3. her suprapubic catheter was changed in the icu. infectious disease was consulted for treatment recommendations. they agreed that sacral decubitus ulcer was the likely source for bacteremia and recommended mr for sacral osteomyelitis as well as tte to for valvular vegetations. blood cultures were followed serially. the echocardiogram, as above, was negative for endocarditis. three subsequent blood cultures grew out mrsa; the last was on . vancomycin was continued. surveillance cultures were followed through and all returned negative. once therapeutic on vancomycin, she defervesced and her white count returned to . she will need to complete a six-week course of vancomycin (last day will be ) for treatment of osteomyelitis. a right picc line has been placed for this purpose. . 2. altered mental status. on admission, she was minimally interactive, somnolent, and disoriented. overnight in the icu, her mental status improved such that she was talking and interactive, with improved speech, following commands and oriented x3 by the first hospital day. this is how she appeared when she was transferred to the medicine floor. it was believed at the time that her altered mental status was due to fever and infection. however, when she did not make significant improvement over the first weekend, neurology was consulted. per their note, the altered mental status was likely secondary to toxic/metabolic encephalopathy in the context of infection. however, they recommended mr for stroke and consideration of lumbar puncture. mr brain showed no acute abnormalities. her mental status continued to improved during the week, although she still has periods of waxing and alertness. her oxygen sats have been fine on ra, cxr was negative for infiltrate, and mr as above was negative. . 3. urinary tract infection / leakage around suprapubic catheter. her first urine culture grew out >100,000 colonies of . she had been started on fluconazole in the unit and her suprapubic catheter changed. however, given that she was not symptomatic, infectious disease offered that she did not need to continue the fluconazole. she was noted to have leakage around her suprapubic catheter. was called and instructed us to restart her oxybutynin which had been stopped for concern of mental status change. she has follow-up planned in clinic as outlined in discharge instructions. . 4. sacral decubitus ulcer and ischial ulcers. she presented with a stage iv sacral decubitus ulcer and two stage iii ulcers over the ischial tuberosities. plastics, consulted in the ed, recommended wet-to-dry dressing changes three times daily, with frequent turning and kinair bed. patient was started on zinc/vitamin c/mvi and nutritional supplements to ensure adequate wound healing. as above, mr sacral spine was ordered to for osteomyelitis. this showed a small fluid collection in the left gluteal soft tissue concerning for abscess. interventional radiology drained this abscess percutaneously under ct-guidance. one cc of bloody pustular fluid was drained that later grew out mrsa. she will continue iv vancomycin as above for a total six week course. dressing changes should continue as outlined in the discharge orders. . 5. hypoxia. initially she required oxygen in the ed and overnight in the icu. chest x-ray showed volume overload but no infiltrate. with treatment of her infection her oxygen requirements gradually improved. we continued her home copd regimen of inhaled steroids and bronchodilators, and her oxygen saturation steadily improved. . 6. fungal infections. we treated superficial fungal infections under the breast and in the groin with miconazole powder. . 7. paraplegia s/p spinal artery infarct. we continued her outpatient baclofen. . 8. abdominal distension/nausea. this improved overnight in the icu and was no longer a problem at time of transfer to the floors. lfts were within normal limits. . 9. osteoporosis. we continued her outpatient calcium, vitamin d, and fosamax. . her diet was progressed to normal diet with ensure supplements. she was kept on subcutaneous heparin for venous thrombosis prophylaxis. her code status is dnr/dni. medications on admission: * alendronate 70 mg weekly on thursday * protonix 40 mg daily * zincate 220 mg daily * mvi daily * vitamin d 800 u daily * asa 81 mg daily * buspar 10 mg * baclofen 40 mg tid * lactulose 30 ml daily * heparin 5000 u sc tid * bisacodyl 10 mg daily * nortriptyline 50 mg qhs * combivent 1 puff q6h prn * tylenol 650 mg po prn * ensure tid with meals * milk of mag 30 ml daily prn * bisacodyl 10 mg pr daily prn * fleet's enema prn * macrobid 100 mg x 10 days (last day ) * advair 250/50 * vitamin c 500 mg * senna * colace 100 mg * gabapentin 900 mg q8h * oxybutynin 5 mg tid * calcium carbonate 1000 mg tid discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po once a week: take one pill every thursday. 2. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 7 weeks: continue through . 3. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for yeast. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. baclofen 10 mg tablet sig: four (4) tablet po tid (3 times a day). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 10. buspirone 10 mg tablet sig: one (1) tablet po bid (2 times a day). 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po daily (daily) as needed for constipation. 13. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). 14. gabapentin 300 mg capsule sig: three (3) capsule po q8h (every 8 hours). 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 17. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 18. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 19. nortriptyline 25 mg capsule sig: two (2) capsule po hs (at bedtime). 20. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 21. heparin, porcine (pf) 5,000 unit/0.5 ml syringe sig: one (1) injection three times a day. 22. zinc sulfate 220 mg capsule sig: one (1) capsule po once a day. 23. combivent 18-103 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis sepsis secondary to osteomyelitis . secondary diagnoses chronic sacral and ischial decubitus ulcers paraplegia secondary to anterior spinal artery infarct hypertension hyperlipidemia gastroesophageal reflux disease chronic obstructive pulmonary disease fecal incontinence discharge condition: vital signs stable. afebrile. discharge instructions: you were hospitalized for treatment of sepsis. we believe the source of the infection was the ulcer over your lower back. cultures we took of the blood grew out bacteria that likely originated from this ulcer. you were treated with intravenous antibiotics for the infection. please continue to take the antibiotics for a period of 6 weeks. because the antibiotics were started on , the last dose should happen on . . your follow-up appointments are listed below. . please call your doctor or return to the emergency room if you have fever, change in mental status, or any other symptoms that are concerning to you. followup instructions: 1. follow-up with dr. clinic , at 3pm: , md phone: date/time: 3:00 . 2. follow-up in infectious disease clinic with dr. : , md phone: date/time: 10:30 . 3. follow-up with your primary care physician, . , as needed: . md procedure: venous catheterization, not elsewhere classified aspiration of other soft tissue diagnoses: esophageal reflux urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension severe sepsis chronic airway obstruction, not elsewhere classified other and unspecified hyperlipidemia osteoporosis, unspecified septic shock pressure ulcer, lower back acute osteomyelitis, other specified sites paraplegia pressure ulcer, stage iv other disorders of muscle, ligament, and fascia infection and inflammatory reaction due to indwelling urinary catheter methicillin resistant staphylococcus aureus septicemia pressure ulcer, stage iii pressure ulcer, hip dermatomycosis, unspecified 

Answer: The patient is high likely exposed to