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: patient recorded as having no known allergies to drugs attending: chief complaint: fever and coccygeal pain major surgical or invasive procedure: 1. bedside debridement of right ischial necrotic tissue history of present illness: 67-year-old man with paraplegia (as a result of an inflammatory spinal cord process of unknown etiology), a chronic indwelling foley catheter, and a known sacral decubitus ulcer was evaluated on an outpatient basis on and was found to have a leukocytosis (wbc 14k); staph aureus was cultured from his sacral decub. cefpodoxime 200 mg twice daily was started. despite this intervention, he remained febrile, and he began having yellow drainage from his ulcer. he was therefore brought to the ed on . there, he was hypotensive (80s/60s). blood and urine cultures were drawn, dexamethasone was given, empiric vanc, levoflox, and flagyl were started, and 3.6 liters of fluid were infused. he was admitted to the icu. on further review of systems, the patient reports a history of progressive night sweats with chills over the past 5-6 months. he's also had a cough productive of increasing amounts of white sputum for the two months pta. he has limited sensation but has felt increased pain in his sacral decub recently. his left-sided, burning chest pain, right-sided abdominal pain, and r>l shoulder pain all started with the onset of his paresis and have progressed steadily since then. blood pressure promptly returned to the range of the patient's relatively low baseline with early goal directed therapy. he was admitted to the icu under the sepsis protocol but required icu-level care for less than 48 hours. fevers are most likely due to sacral osteomyelitis. bone scan non-diagnostic, but suggestive of osteomyelitis. mri likely not possible due to ivc filter; would confirm this with radiology. since we can probe to bone on physical exam, then the diagnosis becomes increasingly likely. referred to orthopedics consult for bone biopsy and discussion of possible ulcer debridement. vancomycin and ciprofloxacin were started pending biopsy. continue aggressive wound care. 3. pulmonary embolism: goal inr . warfarin currently being held. anticipate resuming it today; will need to monitor inr closely on combination of warfarin and cipro. 4. asthma: continue advair and albuterol. 5. cad: asa, simvastatin 6. chf: monitor fluid status and respiration; if flashes in context of fluid loading for sepsis protocol diurese. 7. depression: continue citalopram. 8. back pain/chronic pain: continue dilaudid, baclofen, and gabapentin. 9. fen/gi: on hh diet. replete lytes as indicated. 10. ppx: bowel regimen, anti-coagulation with coumadin, ppi. 11. communication: patient declines to name family members or other persons who could make decisions on his behalf or be contact regarding this admit. 12. code: full-discussed admit, no advanced directives or hcp. 13. access: rij cvc (presep) placed in ed , r ac piv. 14. dispo: pending osteomyelitis work-up. past medical history: 1. inflammatory disease of the spinal cord of uncertain etiology. mra negative for vascular malformation. initial csf analysis showed elevated protein (82) without oligoclonal bands. nmo blood titer negative, rpr negative, lyme serology negative, negative, ro and la negative, ace level normal, neuromyelitis igg negative, esr 70, crp 66.8. ultimately treated with broad spectrum antibiotics, corticosteroids (two weeks of solu-medrol followed by a prednisone taper), and 5 days of mannitol without improvement. he is followed by neurology for a dense paraplegia (t4) with neuropathic pain, restrictive shoulder arthropathy, and a neurogenic bladder requiring a chronic indwelling foley. 2. chronic sacral decubitus ulcer, previously treated with a vac dressing 3. multiple uti (including pseudomonas) 4. pulmonary embolus s/p ivc filter placement 5. asthma 6. two-vessel coronary artery disease s/p cabg 4-5 years ago 7. systolic chf (ef 25-30% on tte) 8. repaired liver laceration 9. chronic back pain 10. vitiligo 11. feeding tube 12. depression 13. mrsa from sacral swab and sputum 14. prior transient episodes of leg paralysis 15. right frontal lobe brain lesion biopsied and c/w gliosis; resolved on repeat imaging 16. abnormal visual evoked potentials social history: he moved here from (after living in many different countries) in the . he is retired from a job in the maritime industry. divorced 24 years ago. three children. quit smoking . quit drinking . no history of illicit drug use or abuse. family history: no stroke, aneurysm, no seizure, no aaa. physical exam: 97.7, 98/68, 80, 20, 97% gen: well appearing male in nad lying in bed. heent: mmm, lips slightly pale, smooth tongue. chest: cta bilaterally, no w/r/r. cv: rrr, physiologic splitting s2, no m/r/g. abd: soft, nontender/nondistended, g-tube in place, c/d/i. extremities: warm, well perfused, no c/c. trace pedal edema bilaterally. skin: vitiligo on hands. large round 10 cm diameter pressure decubitus ulcer on sacrum with appropriate dressing. appears clean with granulation tissue in center, no s/sx of infection. neuro: cn grossly intact. a&o x 3, pleasantly conversant. pertinent results: 07:25am blood wbc-7.6 rbc-3.66* hgb-9.8* hct-30.4* mcv-83 mch-26.9* mchc-32.3 rdw-18.8* plt ct-319 05:00am blood pt-14.3* ptt-30.4 inr(pt)-1.3* 07:25am blood glucose-142* urean-9 creat-0.5 na-140 k-4.3 cl-104 hco3-29 angap-11 06:55am blood alt-10 ast-8 alkphos-100 totbili-0.1 07:25am blood calcium-8.9 phos-3.4 mg-2.2 07:00pm blood cortsol-7.9 07:00pm blood crp-120.3* 08:25pm blood lactate-0.8 07:09pm blood lactate-0.7 02:22pm blood lactate-2.5* 4:00 pm tissue ischial bone. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): escherichia coli. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r anaerobic culture (preliminary): no anaerobes isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): no fungal elements seen. urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- =>16 r vancomycin------------ <=1 s study: left upper extremity venous ultrasound. indication: 67-year-old male with redness, swelling, and pain in the left upper arm. assess for dvt. findings: grayscale and doppler son of the left internal jugular, left subclavian, left axillary, left basilic, left cephalic, and left brachial veins are performed. normal compressibility and waveforms are demonstrated. impression: no evidence of deep vein thrombosis of the left upper extremity. mri of the pelvis without and with iv contrast: impression: 1. large right decubitus ulcer involving the right posteromedial buttock and right proximal medial thigh with right ischial tuberosity osteomyelitis. 2. midline sacral decubitus ulcer with probable osteomyelitis involving the s4 vertebral body and absence of the s5 vertebral body and coccyx suggesting osseous destruction. 3. no evidence of fistulous connection between the gi tract with either the sacral or decubitus ulcer. no focal fluid collections to suggest an abscess are present. 4. diffuse signal abnormality and enhancement of the visualized pevlic musculature suggestive of a myositis which may be inflammatory in nature. bone scan: impression: limited study but findings consistent with osteomyelitis of the distal sacrum, coccyx, and right ischium. cxr: clear chest brief hospital course: 1. acute osteomyelitis secondary to decubitus ulcer due to e. coli - s/p bone biopsy - e. coli -> vancomycin/zosyn for total 6 weeks - flagyl x 6 weeks - prs was consulted for wound care, and recommended dakins solution with wtd dressings - id consultation - follow up with clinic 8/20/07@0930 2. hypotension - chronic - presumed neurogenic due to spinal cord injury 3. uti - enterococcal - vancomycin day (for this) 4. pulmonary embolism - ivc filter - coumadin held for biopsy, restarted at 2 qhs 5. depression - antidepressants were continued 6. cad native vessle, systolic chf - aspirin - b-blocker - acei 7. parapalegia - kinaire bed - turns q2h - pt evaluation 8. lung nodule - outpatient workup 11. communication: patient declines to name family members or other persons who could make decisions on his behalf or be contact regarding this admit. 12. code: full-discussed admit, no advanced directives or hcp. medications on admission: 1. trazadone 25 mg at bedtime 2. coumadin 2 mg qpm 3. tylenol 650 mg q8h prn 4. dilaudid 2 mg q4h prn 5. prostat 30 cc tid 6. xanax 0.25 mg po bid (started ) 7. vitamin c 500 mg 8. aspirin 81 mg po daily 9. baclofen 5 mg po three times daily 10. bisacodyl supp every other day 11. cefpodoxime 200 mg twice daily 12. citalopram 40 mg po daily 13. docusate 100 mg po bid 14. omeprazole 40mg po daily 15. senna 2 tabs 16. simvastatin 40mg po qhs 17. advair 250/50 18. neurontin 800mg tid 19. magnesium gluconate 500mg po bid 20. mvi with minerals daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 4. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 5. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for wheeze. 6. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 8. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 9. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. baclofen 10 mg tablet sig: 0.5 tablet po tid (3 times a day). 12. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. simvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 16. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 17. gabapentin 400 mg capsule sig: two (2) capsule po tid (3 times a day). 18. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 19. sodium hypochlorite 0.5 % solution sig: one (1) appl miscellaneous asdir (as directed). 20. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day). 21. hydromorphone 2 mg tablet sig: 1-2 tablets po q2h (every 2 hours) as needed for pain. 22. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) puff inhalation q6h (every 6 hours) as needed. 23. warfarin 2 mg tablet sig: one (1) tablet po daily (daily). 24. vancomycin 1,000 mg recon soln sig: one (1) gram intravenous twice a day for 5 weeks. 25. piperacillin-tazobactam 4.5 g recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 5 weeks. 26. bed kinair bed discharge disposition: extended care facility: for the aged - macu discharge diagnosis: acute osteomyelitis septic shock - e. coli decubitus ulcer chronic hypotension (neurogenic) uti bacterial (enterococcal) pulmonary embolism depression cad native vessle systolic chf parapalegia lung nodule discharge condition: good discharge instructions: return to the hospital if you experience high fevers, chills, nausea/vomitting, bleeding from the ulcers followup instructions: provider: , md phone: date/time: 9:30 procedure: venous catheterization, not elsewhere classified local excision of lesion or tissue of bone, other bones nonexcisional debridement of wound, infection or burn biopsy of bone, other bones diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis aortocoronary bypass status asthma, unspecified type, unspecified septic shock pressure ulcer, other site chronic systolic heart failure long-term (current) use of anticoagulants pressure ulcer, buttock pressure ulcer, lower back other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism infection and inflammatory reaction due to other vascular device, implant, and graft phlebitis and thrombophlebitis of superficial veins of upper extremities acute osteomyelitis, other specified sites septicemia due to escherichia coli [e. coli] paraplegia acute osteomyelitis, pelvic region and thigh 

Answer: The patient is high likely exposed to