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: history of present illness: this is a 77 year old female with a history of hypertension, diabetes mellitus, status post recent total knee replacement and hip fracture in , chronic renal insufficiency, coronary artery disease status post myocardial infarction, asthma, chronic obstructive pulmonary disease who initially presented from rehabilitation on with fevers to 102 and hypoxia at 89% in the setting of oxygen saturations of 89% on room air. during this subsequent hospital course, the patient was found to have a urinary tract infection and a questionable right lower lobe infiltrate, and blood cultures were positive for gram positive cocci in pairs and clusters which subsequently grew out methicillin-resistant staphylococcus aureus and the patient had five days of methicillin-resistant staphylococcus aureus bacteremia from to at which point the patient was treated initially with vancomycin and gentamicin. in summary, the patient was initially on the medical service prior to and subsequently the patient was taken to the operating room on for an l5-s1 debridement. there was on blood loss and the patient tolerated the procedure well. in the operating room the patient has had an intraoperative transesophageal echocardiogram to further evaluate the cardiomyopathy and showed no valvular vegetation, moderate mitral regurgitation, no aortic insufficiency and ejection fraction greater than or equal to 45%. the swan-ganz catheter was also placed which revealed the central venous pressure of 9, pa pressure of 49/20, cardiac output of 5.12. the patient was subsequently taken postoperatively to the post anesthesia care unit and vent set on ac 600 by 14 with positive end-expiratory pressure of 5 and fio2 of 40%. the patient was subsequently transferred to the medical intensive care unit while intubated for further hospital course. past medical history: please refer to the previously dictated discharge summary dictated on for the previous hospital course and past medical history, medications, social history and relative family history. hospital course: 1. epidural abscess, status post debridement. the patient returned to the medical intensive care unit after epidural abscess debridement. subsequent pathology showed acute osteomyelitis as the source. the patient was maintained on vancomycin dose by level and subsequent cultures from the tissue grew out methicillin-resistant staphylococcus aureus and the patient was maintained on vancomycin dose by level given her creatinine that had continued to rise. infectious disease was initially consulted and under their care as the patient was maintained as a consult throughout the course. they recommended continued coverage with vancomycin, and neurosurgery continued to follow the patient who recommended following the patient's mental status and neurological examination as the sedation from the ventilation was weaned off. the patient was subsequently extubated on . that was uncomplicated with successful wean to pressure support. the patient was initially thought to require tracheostomy, however, after improvement of her respiratory status she no longer needed a tracheostomy. bronchoscopy prior to extubation revealed a large plug that was removed from the left lobe which subsequently improved her breathing status. 2. bacteremia - the patient was dosed by level, given her creatinine with vancomycin. the patient had subsequent blood cultures that were resent giving the rising white count of 12 on and the surveillance cultures have shown no growth to date. 3. aspiration pneumonia - the patient had a history of pseudomonas in her sputum. she was initially started on zosyn but given the creatinine rise and positive eosinophils in her urine this was changed to aztreonam for a total 14 day course which ended on , as per infectious disease records. 4. respiratory status - the patient was intubated post surgery, likely from pulmonary edema and aspiration pneumonia. the patient was continued on ac and was subsequently weaned and extubated on as detailed above with improved oxygenation saturations, as the patient was tolerating 2 liters of nasal cannula on discharge from the medical intensive care unit. 5. atrial fibrillation - the patient was in normal sinus rhythm throughout her course in the medical intensive care unit. she was initially loaded on amiodarone prior to transfer and maintained on lopressor. amiodarone was decreased on , given the loading taper and the patient initially had a long qt, documented to be 490. subsequent decrease of the amiodarone showed that her qtc had resolved. this was also multifactorial in the face of having received haldol during the course. 6. coronary - the patient was maintained on aspirin per neurosurgery and cardiology recommendations and beta blocker as tolerated for her blood pressure. 7. pump - congestive heart failure, the patient had an ejection fraction of 20% per surface echocardiogram. a transesophageal echocardiogram intraoperatively showed an ejection fraction of about 30 to 40%. cardiac monitoring with pa pressures showed a cardiac output of 6 and a pulmonary capillary wedge pressure of 18, likely due to elevated filling pressures. the patient was initially diuresed. swan was discontinued on and the lasix drip was started with a goal of negative 1 liter out. the patient remained total body water overloaded likely with anasarca likely due to low albumin state, and the patient was subsequently diuresed to the point where she became a little more alkalotic and she required more fluid. on the day of discharge she still continues to have 2+ edema peripherally likely due to hyperalbuminemic state. 8. renal - the patient presented with acute and chronic renal failure. initial fena was 6.5 with positive eosinophils on urine smear, prior to transfer to medicine intensive care unit. initial concern was gentamicin toxicity or acute interstitial nephritis due to zosyn. the patient's creatinine continued to rise. renal was involved and they recommended that the patient likely needed higher pressures at the level of the kidney to produce urine with an aim of a systolic blood pressure in the 130s to 140s. the propofol for sedation was weaned off and the patient was subsequently taken off of beta blockade from a hypotension and increasing of creatinine. the patient was also placed on a lasix drip for further diuresis which improved her creatinine slightly but after overdiuresis her creatinine continued to rise but plateaued until the day of this dictation. repeat urine eosinophil smear was negative. 9. herpes simplex virus labialis - the patient was treated with acyclovir which was discontinued on . 10. endocrine - the patient was maintained on an insulin drip which was discontinued on and tapered fingerstick blood glucose. the patient maintained normal glycemia on this. hydrocortisone was initially given at stress doses given her chronic prednisone which was subsequently being tapered off for chronic obstructive pulmonary disease treatment. 11. chronic obstructive pulmonary disease - the patient was maintained on flovent, metered dose inhaler, inhaled, and subsequently started on steroid taper. 12. delta ms - the patient had laughing mania delirium prior to transfer and on arrival to the medical intensive care unit she was intubated and sedated. as she was weaned off of her intubation as the patient was lightened. magnetic resonance imaging scan was obtained which showed no acute process and she was initially started on haldol which was subsequently discontinued given her prolonged qtc syndrome in favor of uveitis. 13. gastrointestinal bleed - on , the patient had a hematocrit drop with some gross melena, however, given her current medical condition, gastrointestinal workup was deferred until the patient was more medically stable. will likely need further gastrointestinal follow up and colonoscopy in the future for evaluation of melena. she responded with 2 units of packed red cells without any further hematocrit drop. 14. fluids, electrolytes and nutrition - the patient was subsequently maintained on tube feeds while she was intubated and planned post extubation with placement of percutaneous endoscopic gastrostomy tube for tube feeds. 15. access - the patient initially had a right swan from her operation on that was subsequently discontinued, given a fever spike and replaced with a triple lumen catheter. code: the patient was full code during this hospital stay. please refer to the remainder of the hospital course which will be dictated by the next intern receiving the care of this patient. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges other endoscopy of small intestine fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other lavage of bronchus and trachea percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells injection or infusion of nesiritide diagnoses: mitral valve disorders urinary tract infection, site not specified atrial fibrillation bacteremia chronic obstructive asthma, unspecified acute systolic heart failure intraspinal abscess acute osteomyelitis, other specified sites diseases of tricuspid valve 

Answer: The patient is high likely exposed to