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: lipitor / cefepime attending: chief complaint: the patient had been in rehab since last d/c unti he was seen by dr. . ct showed complex fluid collection below the lower pole of the incision which corresponded to an area of wound breakdown. he was taken to the or for i+d. major surgical or invasive procedure: : sternal debridement, removal of hardware x3, and left pectoralis muscular flap based on the thoracoacromial vessels. wound exploration, removal of inf plate, vac placed history of present illness: 51 y/o m s/p emergent cabgx4 w/ iabp on with post op course complicated by afib, lv thrombus, dvt, cva with l sided weakness and repiratory failure requiring trach and peg s/p sternal plating on for infected sternum. the patient had been in rehab since last d/c, he was seen by dr. . achest ct done at that time revealed a fluid collection at the lower pole of incision and he was brought to the operating room for drainage and debridement. past medical history: emergent coronary bypass grafting w/intra aortic ballon pump preoperatively post-operative cva lv thrombus lower extremity dvt diabetes mellitus fatty liver dm social history: occupation: computer tech analyst tobacco: denies etoh: social family history: noncontributory physical exam: vs: 97.6 92/54 62 26 95% 50% trach mask, gen: sleeping heent: trach in place cv: distant, rrr pulm: cta bilat w/o wheezes/rhonchi/rales, anteriorly gi: normoactive bs, soft, non-tender, non-distended, g-tube in place msk: no joint swelling or erythema ext: warm and well perfused, no edema, 2+ dp pulses palpable bilaterally skin: no rashes, no decubiti neuro: comfortable, according to wife alert and oriented pertinent results: 03:51pm glucose-117* urea n-14 creat-0.6 sodium-137 potassium-4.0 chloride-100 total co2-28 anion gap-13 03:51pm calcium-9.3 phosphate-3.9 magnesium-1.9 03:51pm wbc-6.7 rbc-3.72* hgb-10.1* hct-29.9* mcv-80* mch-27.2 mchc-33.8 rdw-15.9* 03:51pm neuts-75.5* lymphs-15.8* monos-4.8 eos-2.7 basos-1.1 03:51pm plt count-423 03:51pm pt-22.3* ptt-37.8* inr(pt)-2.1* radiology report chest (portable ap) study date of 4:08 pm medical condition: 52 year old man s/p pec flap final report ap semi-upright radiograph of the chest: interval removal of the sternal plating hardware is performed. the right costophrenic angle is excluded from the field of view. there is no pleural effusion. within these limitations, there is no pneumothorax. heart size is borderline enlarged. hilar contours are unremarkable. there is no pulmonary edema. a left picc is extending up to the cavoatrial junction or probably upper right atrium. there is a second looped wire projecting over the mediastinum, which could be external to the patient. tracheostomy tube is in standard location. impression: no evidence of pleural effusion within the limitations of a partially excluded right costophrenic angle. radiology report ct chest w/contrast study date of 9:28 am medical condition: 52 year old man with h/o mrsa sternal osteomyelitis s/p prior cabg s/p debridement/plates placed in early , now with increased tenderness, erythema in inferior 3rd of sternum, elevated inflamm markers final report since , sternal wires have been removed and transverse costosternal stabilization plates have been applied. at all levels, there is failure of fusion of the sternotomy and the extent of separation between the sternal fragments is either stable or in the lower sternum increased. at several levels the widening is due to both diastasis and bone resorption. for example at 10 cm inferior to the sternal notch, 3:33, the transverse diameter of the right fragment is 14.4 mm now, previously 16.2 mm, and the left is 12.5 mm, previously 16.6 mm while the width of separation is now 10.5 mm, previously 5.6 mm. similar findings are present continuously from that level to the xiphoid. apparent thickening of the caliber of the pectoralis major muscle that may be due to difference in arm position, but there is subcutaneous emphysema of the midline, anterior chest wall at several levels. in the midline presternal soft tissues, 1.5 cm inferior to the sternal notch is a collection of small gas bubbles in the thickened muscle. although the previous midline collection that ran anterior to the manubrium and upper sternal body has been drained, starting 12 cm inferior to the sternal notch, 2:36, and running for at least 6 cm inferiorly, and adjacent to the levels of maximum sternal resorption, is a new midline fluid collection with irregular margins, and maximum transverse diameters of 37 x 23 mm, 2:38. the small volume of retrosternal fluid at these levels is inseparable from a small pericardial effusion at the junction of the lower sternal body with the xiphoid, 2:40-44. although these intrathoracic fluid collections are unchanged since , since they are contiguous with the new, presumably purulent presternal collection, the transthoracic extension of infection cannot be excluded. respiratory motion obscures some of the fine detail in the lung, but there is no pulmonary edema, consolidation, substantial atelectasis and or any nodule. tiny bilateral pleural effusions and small pericardial effusion are unchanged. enlargement of the upper paratracheal lymph nodes has decreased, but the right lower paratracheal complex is 22 mm across in aggregate, previously 19 mm and left lower paratracheal and prevascular nodes have grown from 5 mm to 9 and 8 mm wide respectively. moderate enlargement of the cardiac silhouette, particularly due to a dilated left ventricle, has increased. this study is not designed for assessment of the upper abdomen, but there is no indication of extension of infection to that region. a gastrostomy tube has a normal appearance. impression: 1. development of new lower midline presternal collection (after drainage of the upper portion) and sternal separation, presumably infectious. multifocal bone resorption of the sternal fragments has progressed, concerning for multilevel osteomyelitis. edema of the lower anterior chest wall does not necessarily represent tissue infection. the only reason to presume that a small retrosternal collection and small pericardial effusion, at the levels of the new lower presternal abscess, are not infected, is that neither has enlarged or developed gas collections since late . moderate cardiomegaly, predominantly left ventricular, increased. no pulmonary edema or increase in tiny pleural effusions. 3. tracheostomy, percutaneous gastrostomy, standard appearance. 2:01 pm swab site: sternum sternal wound. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. 2:21 pm tissue site: sternum sternal bone. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. brief hospital course: mr. was admitted for sternal wound debridement and hardware removal. following the procedure a wound vac was placed and the patient was tranferred to the cvicu for further monitoring. he remained in the icu with the vac dressing in place until he was brought back to the operating room for further debridement and pectoralis flap advancement. he tolerated this procedure well and returned to the icu in stable condition. the following day he was transferred to the stepdown floor for continued care. he failed a swallow evaluation and thus tube feeds were continued. he continued to be followed by plastic surgery and infectious diseases services. coumadin was resumed with a heparin drip (1600 units per hour) as his inr had not reached a therapeutic range (2.0-3.0). he received 2.5mg on and 5mg on . he will require referral back to dr. or dr. for coumadin follow-up upon discharge from rehab. the remainder of his hospital course was uneventful. on it was decided he was ready for return to rehabilitation at in nh. he will continue on vancomycin and imipenum to total six weeks. he will require weekly labs every monday which will consist of a cbc, esr, crp, bun, creatinine, vancomycin trough and lft's with results faxed to infectious disease at (. he will remain on tube feeds until his oral intake is adequate and will benefit from close follow-up with speech and swallow. electrolytes should be checked while receiving tube feeds. he will also require aggressive physical and occupational therapy. medications on admission: meds at rehab (from rehab tx paperwork): coumadin - variable (), amiodarone 200 , 81 qd, colace, lansoprazole 30 , simvastatin 20 qd, lisinopril 5 qd, oxycodone prn, cholecalciferol 100 qd, albuterol qid, tylenol prn, lasix 40 qd, spironolactone 25 qd, imipenem 500 q6hr, vanc 1 , riss, reglan 10 tid, insulin glargine 15 , discharge medications: 1. acetaminophen 650 mg/20.3 ml solution : six y (650) mg po q6h (every 6 hours) as needed for pain, fever. 2. carvedilol 3.125 mg tablet : one (1) tablet po bid (2 times a day). 3. simvastatin 20 mg tablet : one (1) tablet po once a day. 4. spironolactone 25 mg tablet : one (1) tablet po daily (daily). 5. furosemide 40 mg tablet : one (1) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet : 2.5 tablets po daily (daily). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 9. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 10. lisinopril 5 mg tablet : 0.5 tablet po daily (daily): hold for sbp<100. 11. oxycodone 5 mg/5 ml solution : 5-10 cc po q4h (every 4 hours) as needed for pain. 12. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. 13. warfarin 1 mg tablet : as directed to maintain target inr 2-2.5 tablets po once a day: target inr 2-2.5. start as he received 5mg . 14. insulin glargine 100 unit/ml solution : twenty (20) units subcutaneous twice a day. 15. insulin regular human 100 unit/ml solution : sliding scale injection qac&hs. 16. heparin, porcine (pf) 10 unit/ml syringe : as directed ml intravenous prn (as needed) as needed for line flush: heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. . 17. imipenem-cilastatin 500 mg recon soln : five hundred (500) mg intravenous q6h (every 6 hours) for 6 weeks. 18. vancomycin in d5w 1 gram/200 ml piggyback : one (1) gm intravenous q 8h (every 8 hours) for 6 weeks. 19. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed for dyspnea. 20. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution : 1600 (1600) units intravenous asdir (as directed): goal ptt 60-80. stop when inr has reached 2.0. discharge disposition: extended care facility: discharge diagnosis: sternal debride, washout, pectoralis flap, closure wound exploration, removal of inf plate, vac placed (dr. pmh: emergent coronary bypass grafting w/ iabp preoperatively post-op cerebral vascular accident, left ventricle thrombus, lower extremity deep vein thrombosis, diabetes mellitus, fatty liver disease, s/p tracheostomy/percutaneous endoscopic gastrostomy tube placement discharge condition: level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. incisional pain well controlled incisions: sternum-clean dry and intact with jp drains. discharge instructions: 1)please shower/wash daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. check incisions daily for redness or drainage 2)please no lotions, cream, powder, or ointments to sternal incision. weigh yourself daily. 3)no lifting more than 10 pounds for 10 weeks from surgery date 4)will remain on heparin drip goal ptt 60-80 until inr is >= 2.0. 5)coumadin for atrial fibrillation, dvt, lv thrombus. goal inr is 2.0-3.0. please arrange for coumadin follow-up upon discharge from rehab. dr. ( or dr. . 6)jp drains managed per plastic surgery and will be pulled in their clinic. please apply bacitracin to jp sites daily. 7)weekly labs while on vancomycin and imipenum. (cbc/bun/creat/lft's/vanco trough/esr/crp). all laboratory results should be faxed to infectious disease r.ns. at ( 8)please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: dr. 1:45pm ( . dr in @1:15pm . provider: , md phone: date/time: 11:30 . provider: care infectious disease phone: date/time: 11:00 . cardiologist dr after discharge from rehabilitation appointment. . pcp: , after discharge from rehabilitation. please call for appointment. . all laboratory results should be faxed to infectious disease r.ns. at ( procedure: enteral infusion of concentrated nutritional substances local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] graft of muscle or fascia removal of implanted devices from bone, scapula, clavicle, and thorax [ribs and sternum] removal of implanted devices from bone, scapula, clavicle, and thorax [ribs and sternum] diagnoses: other primary cardiomyopathies anemia, unspecified atrial fibrillation aortocoronary bypass status other late effects of cerebrovascular disease long-term (current) use of anticoagulants personal history of venous thrombosis and embolism personal history of noncompliance with medical treatment, presenting hazards to health surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled gastrostomy status other chronic nonalcoholic liver disease tracheostomy status disruption of external operation (surgical) wound pathologic fracture of other specified site other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms infection and inflammatory reaction due to other internal orthopedic device, implant, and graft other mechanical complication of other internal orthopedic device, implant, and graft muscle weakness (generalized) 

Answer: The patient is high likely exposed to