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 hypotension major surgical or invasive procedure: picc line removal central line placement history of present illness: 65 yo spanish speaking male with paraplegia, neurogenic bladder with chronic indwelling foley, recurrent utis, chroncic stage iv decubitus ulcer c/b chronic osteomyelitis supposed to be on vanco/zosyn however currently off after seeing id and was doing better, who presents with fever to 103.4 this am. patient is currently on bactrim for uti vs at cooligde house 105/60,108,18 103.4, 95% ra. . patient was recently admitted /08 with hypotension and sepsis requiring icu admission. patient had completed antx for 2 weeks prior to that admission and then vanco/zosyn/bactrim was restarted for empiric chronic osteo treatment. patient had a uti with mixed organisms, blood cultures remained negative. mri was equivocal for worsening ostemyelitis however his inflammatory markers have been trending upwards despite ongoing treatment. patient subsequently returned to with 8 more days of zosyn but then was off all antibiotics for osteomyelitis. he was last seen in clinic at which point it looks like the team thought he was on iv vanco/zosyn. after calling coolige house and finding out that he was indeed off antibiotics the decision was made to hold further treatment given that he was clinically doing well. . in the ed, given cefepime, vanco. a rij was placed due to persistent hypotension initially sbp 70-->100s, down to 80s again. he received a total of 4l ivf with lacate 1.1-->0.8. cvp was 6, svo2 was 82. cxr no infiltrate. . upon arrival to the floor, patient denies any pain, no sob, feels very dry and thirsty. no cp, abd pain, hip pain intermittently past medical history: 1. paraplegia (fell 13 years ago working on construction) 2. depression 3. frequent urinary tract infections --enterobacter and pseudomonas 4. gerd 5. indwelling foley with persistent l sided hydronephrosis (per last dc summary from ) 6. anemia (hct baseline 28-30) 7. sacral decubitus, stage iv, with recent osteomyelitis, s/p approximately 11 wks of vanc/zosyn (completed ), followed by id (dr. ) 8. h/o sepsis requiring icu admission social history: no smoking, no alcohol, no drug use. currently at - . patient may be loosing his apartment due to lack of paying rent while at . family history: mother: no history of mi, ca father: no history of mi, ca physical exam: vs: 98.4 83 80/47 11 96% ra gen: nad, lying in bed heent: op very dry, anicteric perrl neck: supple, rij c/c/i cv: nl s1 s2, distant, no m/r/g lungs: cta, decreased at bases abd: soft, nt n ext: dry, wasted, no c/c/e neuro: a&o x 3, moves upper extremities, no meningismus, cn grossly intact. pertinent results: 02:35am blood wbc-5.8 rbc-2.49* hgb-7.8* hct-23.6* mcv-95 mch-31.3 mchc-33.1 rdw-12.6 plt ct-208 10:30am blood wbc-10.0# rbc-3.25* hgb-10.3* hct-30.4* mcv-94 mch-31.7 mchc-33.9 rdw-13.7 plt ct-334 10:30am blood neuts-57.1 lymphs-37.5 monos-3.8 eos-1.0 baso-0.7 05:26am blood hypochr-1+ anisocy-1+ poiklo-normal macrocy-1+ microcy-normal polychr-normal stipple-1+ 04:02pm blood pt-14.0* ptt-29.9 inr(pt)-1.2* 10:30am blood pt-14.5* ptt-28.9 inr(pt)-1.3* 04:02pm blood esr-81* 05:26am blood ret aut-1.7 02:35am blood glucose-91 urean-17 creat-0.9 na-131* k-3.5 cl-105 hco3-19* angap-11 10:30am blood glucose-107* urean-40* creat-1.5* na-130* k-5.4* cl-100 hco3-20* angap-15 04:02pm blood alt-39 ast-41* ld(ldh)-161 alkphos-70 totbili-0.4 02:35am blood calcium-7.9* phos-1.4* mg-1.6 04:02pm blood albumin-2.8* calcium-7.8* phos-2.5* mg-2.0 05:26am blood vitb12-1293* folate-greater th 10:30am blood cortsol-19.7 10:30am blood crp-28.3* 02:35am blood vanco-27.3* 04:56pm blood type-art po2-92 pco2-34* ph-7.35 caltco2-20* base xs--5 04:56pm blood lactate-0.8 k-3.7 04:56pm blood o2 sat-96 echo : the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: no evidence of endocarditis or clinically-significant regurgitant valvular disease. normal global and regional biventricular systolic function. dilated aortic root. cxr: history: 65-year-old male with fever, hypertension, and central line placement. please evaluate for central line placement. comparison: chest radiograph from 40 minutes prior. single portable upright view of the chest: a right internal jugular line has been partially retracted, and now terminates just at or below the cavoatrial junction. the wire has been removed from the right picc line, obscuring the termination of the catheter tip. lung volumes are again low, and there are likely small bilateral pleural effusions. the lungs are otherwise clear. the bony thorax is unremarkable. impression: interval partial retraction of right ij central line and removal of right picc wire. blood cultures: 2/4 bottles of gpc in clusters, awaiting speciation picc line tip culture: 12:59 pm catheter tip-iv source: picc. **final report ** wound culture (final ): no significant growth. surveillance blood cultures: ngtd brief hospital course: a/p: 65 m with paraplegia, chronic stage vi decubitus ulcer and osteomyelitis, recurrent uti to neurogenic bladder and chronic foley placement who presents with fever and hypotension off antibiotics from nursing home. sepsis: initially hypotensive, febrile and bacteremic, gpc in clusters. likely staph auerus (mrse). vanc x 2 weeks. picc line removed as likely source. wound looked good, no pus drainage, no + wound culture, per plastics seemed to be improving. despite treatment for infection patient would still become hypotensive with sbp in the high 60s or 70s during deep sleep, uop was > 100cc / hr and he would mentate perfectly when awoken so likely some degree of hypotension purely related to sleep and possibly some autonomic dysfucntion but no evidence of poor perfusion. a new picc line was placed after a 3 day line holiday. he will follow up with clinic next week. arf. improved immeidately with fluids, cr 1.5 to 0.9. electrolytes remained stable. chronic sacral decubitus ulcer/osteo: healing well. wet to dry dressing changes per wound care consult. per plastic surgery is improving. - continued zinc, vit c anemia. baseline hct mid 20s. anemia of chronic disease according to iron studies, normal b12 and folate, retic inappropriately low at 1.7 %. smear not notable for significant abnormalities. neurogenic bladder. changed foley. he appears to have chronic colonization. his bactrim was stopped on admission. depression: continued venlafaxine medications on admission: - fluticasone 2 sprays - prilosec 20 mg daily - mvi - trazadone 50 mg q am - zinc 220 daily - colace 100 - effexor 75 mg - vit c 500 - ibuprofen 400 tid - remeron 7.5 mg hs - dulcolax 20 po/pr daily prn - metamucil - tylenol prn - milk of mag prn - percocet 5/325 mg 1-2 tabs q 4 hrs - sodium bicarb 650 daily - hical shake 120 cc qid - bactrim ds 1 tab po bid --since ucx +?? - lactobacillus 1 tab po bid x 10 days discharge medications: 1. vancomycin 1,000 mg recon soln sig: one (1) intravenous twice a day for 10 days. 2. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. hexavitamin tablet sig: one (1) cap po daily (daily). 4. venlafaxine 75 mg tablet sig: one (1) tablet po bid (2 times a day). 5. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 10. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: - discharge diagnosis: sepsis bacteremia neurogenic bladder acute renal failure anemia discharge condition: stable discharge instructions: you were admitted with sepsis from a line infection. you have a new iv that was placed during this hospitalization. you will need to have antibiotics for a total of 14 days. please return to the er if you develop fevers, chills, confusion or new symptoms. followup instructions: provider: , md phone: date/time: 9:00 provider: surgery clinic phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: anemia, unspecified esophageal reflux acute kidney failure, unspecified unspecified septicemia depressive disorder, not elsewhere classified sepsis constipation, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pressure ulcer, lower back accidents occurring in other specified places pressure ulcer, heel other and unspecified infection due to central venous catheter paraplegia neurogenic bladder nos 

Answer: The patient is high likely exposed to