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: haldol / penicillins / augmentin attending: chief complaint: uti major surgical or invasive procedure: right internal jugular central venous line peg replacement picc line placement history of present illness: mr. is an 87 yo male s/p cva, nonverbal at baseline, who presents from rehab with fevers and hyperglycemia. his daughter provides the history. mr. has had fevers for the past week. he has also had cough and intermittently was noted by daughter to have mild sob. he was treated for pna with levo/flagyl. he continued to have fevers and had labwork sent. per the daughter, the pt's physician was concerned about the labs and recommended evaluation in the ed. in the ed at , initial vs 97.1 112/73 70 2 97 ra. ua was positive for uti with wbc 12.1. serum sodium was noted to be 155. he recieved 3l ns in the ed. he was treated with vanc/cefepime. he was given 5 units reg insulin for glucose 474. past medical history: s/p cva left frontoparietal and temporooccipital , nonverbal, s/p peg placement traumatic subdural hematoma x 2 htn type ii dm dementia atrial flutter: off warfarin due to traumatic subdural x 2 social history: lives in health center. supportive daughters and wife. chinese restauranteur. no tobb or etoh family history: no family history of pulmonary disease obtained physical exam: admission exam vs: temp: 97.1 bp: 83/58 hr: 82 rr: 22 o2sat: 99 ra gen: resting in bed, non-verbal, nad heent: perrl, eomi. mucous membranes moist. no oral ulcers. neck: supple, no lad, no jvp elevation. lungs: cta bilaterally, no wheezes, rales, rhonchi. normal respiratory effort. cv: rrr, no murmurs, rubs, gallops. abdomen: soft, nt, nd, nabs, old midline scar, g-tube in place extremities: no cyanosis, clubbing, edema. neurological: alert and oriented x 3, psychiatric: appropriate. pertinent results: 01:05am urine color-yellow appear-hazy sp -1.025 01:05am urine blood-lg nitrite-pos protein-tr glucose-1000 ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 01:05am urine rbc-* wbc->50 bacteria-many yeast-none epi-0-2 12:53am comments-green top 12:53am lactate-3.3* 12:35am glucose-474* urea n-76* creat-1.5* sodium-155* potassium-4.2 chloride-121* total co2-21* anion gap-17 12:35am estgfr-using this 12:35am alt(sgpt)-7 ast(sgot)-14 alk phos-62 tot bili-0.4 12:35am lipase-57 12:35am calcium-8.6 phosphate-2.9 magnesium-3.1* 12:35am wbc-12.1*# rbc-4.09*# hgb-13.0*# hct-40.9# mcv-100* mch-31.8 mchc-31.8 rdw-14.9 12:35am neuts-79.7* lymphs-14.5* monos-2.8 eos-2.6 basos-0.4 12:35am plt count-145* 12:35am pt-13.4 ptt-23.7 inr(pt)-1.2* . cxr : upright radiographs of the chest: mildl enlargement of the cardiac silhouette is chronic. the aorta is tortuous. lungs are clear. healed right posterior rib fractures include the right third, fourth, sixth, seventh, eighth and ninth ribs. . micro: urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. presumptive identification. 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. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | staph aureus coag + | | ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 8 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s <=0.5 s levofloxacin---------- 4 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s <=16 s oxacillin------------- =>4 r piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tetracycline---------- <=1 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s <=0.5 s vancomycin------------ <=1 s . fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . 11:48 am stool consistency: watery source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . . axr : history: 87-year-old man with sepsis, recovering, but more distended with diarrhea, evaluate for colonic distention. technique: a supine abdominal x-ray dated at 11:15 a.m. was obtained. comparison is made to a prior ct scan of the abdomen and pelvis dated . findings: scattered gas and stool is seen throughout the colon. no evidence for small- bowel obstruction. no obvious free air. a g-tube projects over the left upper quadrant. multilevel degenerative changes are seen in the lumbar spine. impression: nonspecific bowel gas pattern. the study and the report were reviewed by the staff radiologist. impression: multiple healed right rib fractures. . ct abdomen/pelvis with oral contrast : ct abdomen/pelvis with contrast: in the visualized lung bases, there are new small bilateral pleural effusions, left more than right. there are associated atelectasis in both bibasilar region, however, cannot rule out superimposed infectious process. the cardiac size is within normal limits. in the abdomen, the assessment of parenchymal organs are limited by the non-iv contrast study. the liver appears unchanged, without focal abnormality. the gallbladder is not well visualized. the pancreas slightly appeared to have fatty replacement but otherwise within normal limits. the spleen, adrenal glands, and kidneys are unchanged and within normal limits. in the left lower pole of the kidney, there is a calcific exophytic density, likely represents a calcified renal cyst, unchanged in appearance. bilateral perinephric fat stranding in the anterior pararenal space, nonspecific, is unchanged. the indwelling peg tube is malpositioned, with the balloon partially intralumenal and partially in the subcutaneous track. there is no evidence of extraluminal oral contrast leak. the stomach, duodenum, loops of small bowel and colons are patent with oral contrast, without evidence of bowel obstruction. there is interval minimally increase of the bilateral pericolonic fat stranding, left more than right, but no evidence of colonic wall thickening to suggest acute colitis. this fat stranding appears to be extending from the perinephri fat stranding. a small region of fat stranding is also seen subjacent to the aortic bifurcation, also non- specific. a small amount of stool is noted in the rectal vault, with unchanged appearance of perirectal fat stranding and minimally prominent rectal wall. there is an indwelling foley catheter, with a balloon inflated inside the prostate. evaluation of the collapsed bladder is limited, but no gross abnormality is identified. there is no free fluid or air in the intra- abdominal cavity or the pelvis. several small, scattered lymph nodes are seen in the messenteric, retroperitoneal and inguinal regions, but no lymphadenopathy is identified. there is no fluid collection in either the abdomen or pelvis suspicious for abscess. bone window: there is an unchanged l2 compression fracture, but no acute fracture or dislocation. significant vascular calcification is seen along the descending aorta and its major branches. no lytic or blastic lesion suspicious for metastasis is identified. impression: 1. no definite evidence of acute colitis. nonspecific mild pericolonic fat stranding in the descending colon, without colonic wall thickening. 2. no fluid collection suspicious for abscess. 3. the peg balloon is malpositioned, partially dislodged in the subcutaneous track, but no evidence of oral contrast leak. 4. foley balloon inflated inside the prostate. 5. unchanged l2 compression fracture. . cxr : impression: ap chest compared to and 31. pulmonary and mediastinal vascular congestion accompanied by small increasing right pleural effusion suggests that the basal predominant opacification in the lungs is due to pulmonary edema and not pneumonia. mild cardiomegaly stable. right jugular line ends in the svc. . tte : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is moderately dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. mild (1+) mitral regurgitation is seen. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. there is borderline pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. no obvious echocardiographic evidence of valvular vegetations. mild symmetric left ventricular hypertrophy with preserved global left ventricular systolic function. dilated thoracic aorta. right ventricular dilation with borderline normal function. mild mitral and aortic regurgitation. if clinically indicated, a transesophageal echocardiogram may better assess for valvular vegetations. brief hospital course: 87 yo m with recent stroke admitted to the medical floor for fever and hyperglycemia. pt was hypotensive shortly after admission to the floor, requiring an icu admission for hypotension, hypernatremia, and hyperglycemia. . icu course the patient was transferred to the icu after hypotension on the floor. central access was obtained and fluid rescusitation commenced. the patient did not require pressor support or intubation. he was found to have an e.coli/staph aureus uti which was initially covered with vanc/zosyn/cefepime and transitioned to bactrim prior to transfer back to the general medical floor. after initial volume repletion, the patient was transitioned to an insulin gtt and d5w to correct hyperglycemia and hypernatremia. over a 72 hour period his na was reduced from 160 to 146 and his insulin was transitioned to lantus with sliding scale. prior to callout, the patient developed a 4 second pause with intermittent sinus bradycardia on telemetry. his donepezil was discontinued and his heart rate normalized to the 60s. . the following is the remainder of his course by problem after transfer back to the general medical floor: . # hypotension/fever: his hypotention initially resolved with ivf in the icu. his lisinopril, norvasc, baclofen, and flomax were held. once bp began to normalize, baclofen and flomax were resumed. pt was treated with vanc/zosyn/cefepime initially in the icu,and then tailored to bactrim to treat his staph aureus/e coli uti. on the evening of transfer back to the floor on , the patient again became febrile to 101.9 with sbp in the 70s. his antibiotic coverage was extended to vanc/cefepime/flagyl for broad abdominal/pulmonary/urologic coverage, and he was bolused 4 l ns. his baclofen and flomax were again stopped. continued to hold bp meds. repeat cxr showed a possible new lll pna, however subsequent cxr relayed that this was more likely effusion/atelectasis in the lll. given his abdominal distension and diarrhea, ct abdomen/pelvis was performed. this showed no obstruction, colitis, or abscess. he also had no noted sacral osteomyelitis or abscess. esr was only 24. c diff was negative x 3 and stool cultures were negative. repeat ua still appeared dirty so urine culture was again sent but was negative. repeat blood cultures were negative. tte on showed no vegetations and ef of 55%. he was continued on vanc/cefepime/flagyl to cover for potential aspiration pna (as pt was noted to be aspirating while here), and to cover his uti. he was afebrile for 48 hours at the time of discharge and will complete 8 days of vanc/cefepime/flagyl . # bradycardia: the patient has developed pauses, sinus bradycardia to the 50s, and bursts of tachycardia in the high 90s while in the icu. this rhythm is preliminarily consistent with sick sinus syndrome. the patient is not on any culprit medicines (beta blockers, lithium, digoxin, cimetidine). aricept was stopped as this can cause bradycardia. once transferred back to the floor, the pt continued to have pauses up to 2 seconds and hr in the 50s. he would also have bursts of hr up to 120s. discussion of pacemaker was not pursued at this time in the setting of infection, but if pt has persistent pauses or symptoms, then pacemaker discussion may need to occur in the future. . # hypovolemic hypernatremia: due to on-going insufficient free water repletion. as per above, na was as high as 160 on transfer to the icu. with ivf and free water flushes through his peg, his na normalized prior to transfer back to the general medical floor. na was 139 at discharge. . # e. coli & staph aureus uti: pts urine grew e coli and staph aureus, both sensitive to bactrim. given staph aureus in the urine, blood cultures were checked but were negative. he was admitted with a foley in place (had chronic foley since ), which may be the culprit. initially was treated with vanc/cefepime/zosyn, but tailored down to bactrim based on urine sensitivities. as per above, once pt was hypotensive again, his antibiotics were again changed back to vanc/cefepime/flagyl and ua/urine culture were repeated. this second culture on antibiotics came back negative. would complete course of vanc as per above. . # hyperglycemia/dmii: pts lantus dose was increased as needed for initial fingersticks in the 400s. he was also managed on sliding scale insulin. . # ?altered mental status: pt was very lethargic on admission. likely lethargic due to infection/dehydration in setting of underlying dementia. discussed with family, and at baseline pt will often open his eyes and acknowledge his family when they come to visit, but at times he will sleep for 1-2 days straight. confirmed with family that his mental status while here was at baseline. noted to often resist us opening his eyes, nonverbal, not interactive, often sleeping. . # pulmonary edema: pt had noted edema on cxr on after 4 l ns fluid resuscitation. no lasix was given due to low bp initially. oxygen saturation remained mid 90s on room air. tte on showed normal ef at 55%. on day of discharge , pt had increased wheezing and crackles in his lungs on exam (still satting 98% ra), so given lasix 10 mg iv x1. as bp tolerates, pt may need some gentle diuresis after the aggressive fluid resuscitation he received here. . # acute renal failure: admission cr had been 1.5, up from baseline of 0.9. lisinopril was held and pt was given ivf. his creatinine improved with ivf to 0.9 at discharge. . # history of traumatic subdural: continued keppra for seizure prophylaxis . # decubitis ulcer: pt has a stage iii ulcer on his upper r trochanter and a stage ii on his sacrum. also has a r heel ulcer. seen by wound care. he will need frequent ulcer monitoring, turning in bed, etc. . # peg tube replacement: pts peg tube fell out on after returning from ct scan. his tubefeeds were held and his peg tube was replaced by ir on . . # anasarca: albumin low at 2.7. nutrition recommended adding benefiber to his tube feeds. . # leukopenia: wbc was lower at 3.5 on both and . be dilutional or related to vancomycin. would repeat cbc on to ensure wbc is stable. . # atrial fibrillation: currently not anticoagulated due to sdh, supposedly from falls. he is on asa 81 mg daily. can consider anticoagulation as outpatient given that his greatest risk of fall is with the lift, which is a modifiable risk factor. no rate control given h/o bradycardia. . # diarrhea/abdominal discomfort: pt had diarrhea while here, requiring rectal tube. c diff was negative x 2. pt has been on antibiotics, which may have been causing his current diarrhea. pt had some tenderness on exam with palpation. given persistent fevers/hypotension, ct abdomen/pelvis was performed on . this showed no obstruction, colitis, or abscess. he also had no noted sacral osteomyelitis or abscess. ct abdomen did note foley in prostatic urethra, so pts foley was advanced and his abdominal pain resolved. diarrhea also was slowing by time of discharge so his rectal tube was removed. . # bph: flomax was stopped due to hypotension. if a voiding trial is to be performed in the future, would resume flomax 1 week prior. . # s/p cva: pt is on baclofen at baseline. it has been held due to recent hypotensive episodes. can consider restarting as bp remains stable (had been on 2.5 mg three times a day). . # goals of care: discussed with pts wife, daughter , and daughter . pts family wants pt to be full code at this time, but would not want extended life support. medications on admission: docusate sodium 50 mg baclofen 2.5 mg tid tamsulosin 0.4 mg qhs amlodipine 5 mg daily trazodone 75 mg po hs paroxetine hcl 30 mg daily ascorbic acid 500 mg thiamine hcl 100 mg daily folate 1mg qd aspirin 81 mg daily lansoprazole 30 mg daily levetiracetam 500 mg/ml donepezil 5 mg qhs magnesium hydroxide 400 mg/5 ml 30 ml po q6h prn bisacodyl 10 mg daily prn lantus 14 qhs with hiss calcium carbonate 1,250 mg/5 ml(500 mg) tid cholecalciferol (vitamin d3) 400 unit daily acetaminophen 1000 mg tablet tid prn pain lisinopril 2.5 mg daily discharge disposition: extended care facility: discharge diagnosis: hypernatremia hypotension urinary tract infection acute renal failure discharge condition: stable. discharge instructions: you were admitted with confusion, high sodium, dehydration, acute renal failure, and a urinary tract infection. your blood pressure dropped while you were here, requiring admission to the icu. your blood pressure again dropped, and you were started on broad spectrum antibiotics. your blood pressures have improved, and you have had no more fevers for over 48 hours. . the following medication changes have been made: your lisinopril and norvasc have been stopped due to low blood pressure. your baclofen and flomax have also been held due to low blood pressure. your aricept has been stopped in case this was causing your low heart rate. your lantus was increased to 29 units a day. you will need to complete 4 more days of antibiotics. . call your doctor or go to the er for any worsening confusion, recurrent fevers, abdominal pain, vomiting, persistent diarrhea, or any other concerning symptoms. followup instructions: please follow up with dr. after discharge. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified replacement of gastrostomy tube diagnoses: unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial flutter other persistent mental disorders due to conditions classified elsewhere pulmonary collapse methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site pressure ulcer, lower back diarrhea urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pressure ulcer, heel sinoatrial node dysfunction hyperosmolality and/or hypernatremia late effects of cerebrovascular disease, aphasia infection and inflammatory reaction due to indwelling urinary catheter mechanical complication of gastrostomy pressure ulcer, stage iii pressure ulcer, hip 

Answer: The patient is high likely exposed to