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: sulfa (sulfonamides) / oxacillin / heparin agents attending: chief complaint: line sepsis major surgical or invasive procedure: hemodialysis hemodialysis catheter replacement mechanical ventilation transesophageal echocardiogram midline placement history of present illness: mr. is a 71 year old man with pmh significant for esrd on hd and endocarditis who was admitted to on with respiratory failure and endocarditis following a hospitalization at for mrsa septic shock. he had been recovering there until day of arrival, when he was found to have a fever of 101.0. he was found to be growing vre and was started on linezolid on day of admission. it is not clear if this was from a surveillance culture or if he had been spiking fevers prior to day of arrival. while at , vanco had been dosed by level throughout his course, with the last level 30 on . of note, he was dialyzed today through the tunnelled catheter that was placed in his groin in by ir. at baseline, the patient is oriented x with periods of confusion. he was transferred to this facility for change of hd access. past medical history: 1. esrd on hd, anuric, m, w, f tunneled catheter 2. atrial fib/ddd pacer interrogation 3. cad s/p stent mild 40% prox lad on cath '. echo showed ef > 60% on , mod pulm htn, no significant valve dz. normal mibi in . 4. hypothyroid 5. peg 6. h/o lue dvt (on coumadin) 7. htn 8. ? hit 9. left total knee replacement 10. multiple line infections 11. h/o presumable mrsa endocarditis and sepsis (could not be confirmed with tte) tee not perfomred as pt has esophageal narrowing on egd in past. 12. anemia of chronic disease (on epo) 13. vented since line sepsis, mrsa pna, recurrent 14. history of tuberculosis as a child and now with negative ppd 15. dm (?) 16. vre in urine in social history: retired dentist, was living in with wife, kids, and , denies etoh/tob. family history: both parents died in 90's, healthy. physical exam: t 99.7 hr 69 bp 198/92 rr 30 93% vent: 550 x 12 40% peep 5 gen: agitated, heent: mmm, pupils reactive neck: trach in place, no lad, bilateral 4-6 cm area of nontender edema over shoulders cor: rrr 1/vi systolic murmur best heard over llsb pulm: ctab no crackles abd: obese, well healed surgical incisions, ntnd + bs no hepatosplenomegaly ext: wwp, dp/pt/radial pulses 2+, no splinter hemorrhages, osler nodes neuro: hand grip otherwise patient did not comply with exam, + asterixis, could not evaluate cranial nerves although palate elevated symmetrically. pertinent results: admission: 10:20pm blood wbc-10.8 rbc-3.13* hgb-9.1* hct-27.6* mcv-88 mch-28.9 mchc-32.8 rdw-18.9* plt ct-186 10:20pm blood neuts-90.6* bands-0 lymphs-5.1* monos-3.8 eos-0.4 baso-0.2 10:20pm blood pt-17.1* ptt-28.0 inr(pt)-2.0 10:20pm blood glucose-49* urean-34* creat-2.2* na-140 k-5.5* cl-107 hco3-27 angap-12 10:20pm blood alt-44* ast-79* alkphos-471* totbili-0.4 10:20pm blood calcium-8.6 phos-1.6* mg-2.2 09:34am blood type-art po2-114* pco2-35 ph-7.47* calhco3-26 base xs-1 10:53pm blood lactate-1.7 : 04:33am blood wbc-14.7* rbc-3.68* hgb-10.5* hct-33.8* mcv-92 mch-28.6 mchc-31.1 rdw-18.4* plt ct-105* 04:33am blood glucose-68* urean-40* creat-3.1* na-139 k-4.8 cl-107 hco3-24 angap-13 04:33am blood calcium-9.5 phos-3.4# mg-2.5 11:46am blood type-art temp-38.4 rates-20/2 tidal v-500 peep-10 fio2-80 po2-78* pco2-55* ph-7.23* calhco3-24 base xs--5 aado2-440 req o2-75 intubat-intubated vent-controlled ct head : no evidence of hemorrhage or infarction. evidence of chronic ischemia and right maxillary sinus and bilateral mastoid opacification, unchanged since . cxr : bilateral multifocal pneumonia, and/or a moderate degree of congestive failure. echo : 1. the left atrium is mildly dilated. the left atrium is elongated. the right atrium is moderately dilated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 3.right ventricular chamber size is normal. right ventricular systolic function is normal. there is an echogenic density in the right ventricle consistent with a pacemaker lead. 4.the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. 5.the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. physiologic mitral regurgitation is seen (within normal limits). 6.there is moderate pulmonary artery systolic hypertension. 7.there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , no change. impression: no echocardiographic evidence of endocarditis. picc placement : 1. successful placement of a 21 cm, single lumen midline catheter with tip in the left subclavian vein, ready for use. 2. venogram demonstrates stenosis at the junction of the left subclavian and brachiocephalic veins. tee : conclusions: despite multiple attempts, the tee probe could not be passed into the esophagus. at baseline, the patient was hypotensive, on vasopressors, with difficult intravenous access, therefore deeper sedation was deemed unsafe from the hemodynamic standpoint. tee was therefore aborted. cxr : no significant interval change in the appearance of the right mid lung infiltrate, pulmonary vascular congestion, and pleural effusion since the prior study. cxr : increased pulmonary edema compared to with unchanged probable multifocal pneumonia. brief hospital course: assessment: 71yo man with esrd on hd< cad s/p pci, paroxysmal afib s/p ppm, ?hit, recurrent line bacteremia, ventilator-dependent since , admitted with vre line bacteremia and pseudomonas multifocal pneumonia, progressively deteriorated without alternative options for treatment, until goals of care were made to be comfort measures only. hospital course is discussed below by problem: 1. line sepsis: he was found to have vre from his hemodialysis catheter. this was removed and replaced twice. in addition, he was treated with many antibiotics, including (at the end of his hospitalization) daptomycin, colistin, metronidazole, and ambisome. his lines continued to be infected. the idea of treating him with an "antibiotic lock" using ambisome, daptomycin, and argatroban in a heplock was considered, but no studies of safety and efficacy had been done investigating this method. the id team was following his care closely throughout the hospitalization. 2. hypotension: the patient was found to be recurrently hypotensive. this was most likely secondary to sepsis, as he had both a line infection and a pneumonia that could not be treated effectively. in addition, he became hypotensive with increases in peep and with hemodialysis. he was initially treated with small fluid boluses, changes in ventilator settings, and adjustments to hemodialysis, but eventually had to be placed on levophed. this medication, however, was not enough to maintain his blood pressure, and it was discontinued when the patient was made cmo. he did not have any available access to start another pressor. 3. respiratory failure: this was thought to be secondary to either septic emboli from his line, pneumonia, or ards (from sepsis or volume overload). volume overload was considered less likely as his respiratory status worsened after being dialyzed. despite aggressive antibiotic treatment, including courses of linezolid, daptomycin, levofloxacin, cefepime, meropenem, colistin, and flagyl, the patient continued to decline, until his ventilator settings were difficult to manage in conjunction with his hypotension and desaturations. when the goals of care were changed to comfort measures only, the patient was taken off the ventilator. 4. atrial fibrillation: the patient had several episodes of paroxysmal atrial fibrillation with rates in the 150s. these resolved quickly, once with the administration of po amiodarone (likely not causal given the route of administration). the patient was maintained on po amiodarone as well. he could not be given a beta blocker or calcium channel blocker due to his hypotension. 5. esrd on hd: during the hospitalization, the renal service was closely following and administering hemodialysis when appropriate. this was stopped when it was no longer feasible given his hypotension and lack of access. 6. leukocytosis: as above, this was likely secondary to infection. a tee was recommended by the id service but was unable to be performed due to the patient's agitation without sedation and hypotension with sedation. 7. glucose control: he was maintained in the hospital on lantus while his tube feeds were running and a sliding scale of insulin for tighter blood sugar control. 8. elevated inr: he was noted to have an elevated inr, temporally related to coumadin, which resolved s/p ffp, and vitamin k. 9. access: his hemodialysis catheter and midline were both replaced, but there were no alternative ways of managing the hd catheter infection. he was getting levophed through his midline, but did not have any way to get better access. he had no good indication for central line attempts, as they would likely be unsuccessful and would cause more harm than benefit. his family decided to make the goals of care comfort measures only and all additional treatment measures were withdrawn. medications on admission: citalopram 30 q48, linezolid 600 q12, haloperidol 2 mg q 8 prn, lorazepam 0.25 mg q 8, acetominophen 650 q6 prn, alteplase 2 mg iv 3 x week, bisacodyl 10 mg pr q12 prn, insulin regular q12, hydroxyzine 25 mg q8, nepro strength 50 ml/hr, epo 15,000 units 3 x week, percocet q 6 prn, lansoprazole 30 qd, iron 300 mg qd, b12 1000 mcg qd, amio 200 mg qd, senna 1 tab q12, metoprolol 25 q12, docusate 100 mg q12, ipratrop/albuterol 4 puffs q4 prn. discharge medications: n/a discharge disposition: extended care discharge diagnosis: sepsis pseudomonal pneumonia vancomycin resistent enterococcal line infection discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis transfusion of packed cells transfusion of other serum diagnoses: anemia of other chronic disease end stage renal disease unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified severe sepsis unspecified acquired hypothyroidism atrial fibrillation pneumonia due to pseudomonas other specified septicemias disseminated candidiasis infection and inflammatory reaction due to other vascular device, implant, and graft encounter for palliative care hyperosmolality and/or hypernatremia other and unspecified coagulation defects dependence on respirator, status 

Answer: The patient is high likely exposed to