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: banana / melon flavor / avocado / iv constrast / lorazepam attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: 65 year old female with hx of stage squamous cell cervical cancer, status post combined chemoradiation with b/l nephrostomy tubes and a recent history of multiple utis with both coag pos staph and e.coli transferred from onc clinic to ed for hypotension. patient was feeling well until yesterday when started feeling fatigue, and then had sudden onset of chills last night with weakness and a fall onto bilateral knees on her way to the bathroom. no loc or head strike. this am temp at home was 101. pt also had multiple bouts of explosive diarreha this am without abdominal pain or nausea. later in morning was unable to come in to onc clinic for urgent visit and was instructed on phone to come to er as pt was febrile to 101.5 with sbp 90's although mentating well. was due to have nephrostomy tube check with plan to remove l sided tube . of note, her electrolytes have needed aggressive repletion as outpatient has well with pt on standing k and mag until recently when k was stopped. . in the ed, initial vs were: temp 101, hr 104, bp 76/44, rr 16, sats 97%. she was started on peripheral levo initially and given vanco/zosyn. nephrostomy tubes have urine c/w with uti. lactate initally 6 improved to 3.5 with fluids and pressors. given thiamine as study drug. labs notable for cr to 2.2 (baseline 1.1), bandemia to 10%, hypok, hypophos, and hypomag. given k and mag in ed. bcx, ucx sent. she had a femoral cvl placed as left ij couldn't be obtained but was attempted. post procedure cxr no ptx per resident. she had received 6l of ivf by time of transfer to floor. pt has a port which was accessed. ? l hematoma. femoral line for access. on prednisone 5mg daily at baseline. given 125mg solumedrol in ed. prior to leaving ed vitals showed p 82 bp 110/40 r16 o2 sat 99%2l. . in the icu, pt in nad complaining mostly of knee pains and tiredness. reporting no diarrhea since this morning. bp in low 100s on 0.3 of norepi. . review of sytems: denies dysuria, hematuria, or frequency. reports continuing feverish/chills sensation. denies abdominal pain, headache, confusion, dizziness, difficulty breathing, chest pain. past medical history: -status post resection of a benign pituitary adenoma at age 21 at with resultant hypopituitarism; she was previously followed at , last saw endocrinology at - in . -cervical cancer: followed by dr. , discovered after post-menopausal vaginal bleeding/hematuria and was found to have a cervical mass w/ invasion of the posterior bladder wall. biopsies revealed a locally advanced, stage squamous cell cervical carcinoma. underwent nephrostomy tubes for hydronephorosis. she initiated radiation therapy on with her last session . she completed 6 sessions of weekly cisplatin on . -multiple utis since nephrostomy tube placement earlier this year -osteoporosis -multiple food allergies social history: she grew up in the west end of . she lives in , ma with her husband . they have two daughters, her eldest lives nearby, her daughter lives in new . her sister from , , is back in . hopes to travel to later this spring. the patient smoked approximately one-third to pack per day for 33 years, recently quitting. she had one alcoholic beverage daily until her illness. family history: brother died of leukemia at age 64 in . pt was a match, donated peripheral blood stem cells. both parents had heart disease. physical exam: exam on admission: vitals: t: 97.9 / bp: 133/49 / p: 81 / r: 15 / o2: 99% on ra general: alert, oriented although very tired, no acute distress heent: sclera anicteric, mmm, oropharynx clear, pupils slightly constricted but equal and reactive bilaterally neck: supple, jvp not elevated, no lad, autramuatic lungs: trace crackles at r base, rest of lung fields ctab with no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds hypoactive, no rebound tenderness or guarding, no organomegaly gu: foley in place, pale urine in foley bag back: no pain at midline with sitting/lying movements, bilateral cva tenderness with light touch in areas around urostomy tubes. both urostomy tubes in place without surrounding erythema/induration ext: warm, well perfused, 2+ pulses at dp and radial, no clubbing, cyanosis or edema, bilateral knees are painful to palpation just below kneecap (r>l) with small purple bruise below r kneecap, limited active rom due to pain with better passive flexion and extension, no skin breaks on either knee. r upper arm is painful to palpation on lateral aspect. no bruises or masses noted on exam. limited ability to raise r shoulder due to pain. . pertinent results: labs on admission: 11:00am blood wbc-13.1*# rbc-2.95* hgb-9.5* hct-26.5* mcv-90 mch-32.3* mchc-36.0* rdw-16.0* plt ct-169 11:00am blood neuts-83* bands-10* lymphs-3* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 11:00am blood hypochr-normal anisocy-1+ poiklo-1+ macrocy-1+ microcy-normal polychr-normal ovalocy-1+ tear dr1+ 07:10pm blood pt-17.3* ptt-30.4 inr(pt)-1.6* 05:07am blood fibrino-509* 11:00am blood gran ct-* 11:00am blood urean-16 creat-2.2*# na-133 k-2.8* cl-96 hco3-25 angap-15 11:00am blood alt-29 ast-38 ck(cpk)-163 alkphos-108* totbili-0.3 11:00am blood albumin-3.3* calcium-8.4 phos-1.1*# mg-1.1* 11:00am blood cortsol-6.9 01:12pm blood lactate-5.9* k-3.1* 11:00pm blood freeca-1.17 . labs on discharge: 06:45am blood wbc-9.6 rbc-3.28* hgb-10.2* hct-29.4* mcv-90 mch-31.0 mchc-34.6 rdw-17.3* plt ct-123* 06:45am blood glucose-75 urean-11 creat-0.9 na-138 k-3.5 cl-97 hco3-32 angap-13 06:45am blood vanco-32.3* . microbiology: blood culture, routine (final ): staph aureus coag +. _______________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- s vancomycin------------ 1 s . . urine culture (final ): staph aureus coag +. >100,000 organisms/ml. enterococcus sp. >100,000 organisms/ml. _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- =>16 r vancomycin------------ 1 s . imaging: cxr: no acute pulmonary process. stable chest x-ray exam. . echo: the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. the mitral valve leaflets are structurally normal. 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 to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. no masses or vegetations are seen on the pulmonic valve, but cannot be fully excluded due to suboptimal image quality. there is no pericardial effusion. . compared with the findings of the prior study (images reviewed) of , the findings are similar but the technically suboptimal nature of both studies precludes definitive comparison. . impression: suboptimal image quality. no vegetations seen . brief hospital course: the patient is a 65 year-old female with hx of stage squamous cell cervical cancer, status post combined chemoradiation with bilateral nephrostomy tubes admitted with urosepsis. . # urosepsis: initially admitted to icu, requiring pressors given hypotension in setting of sepsis. urinary source believed to be most likely given positive ua and bilateral cva tenderness. cxr and c.diff returned negative. the patient was started on vancomycin and cefepime empirically given recent staph aureus utis and the possiblity of resistant organisms. the patient was also given two days of stress dose hydrocortisone. the patient's symptoms resolved with broad-spectrum antibiotics, and she was weaned off pressors and transferred to the floor. . the patient's urine culture grew methicillin-resistant staph aureus and enterococcus; her blood culture grew methicillin-resistant staph aureus. urology was consulted during her stay with dr. recommendation to keep tubes in place until outpatient follow-up. echo returned negative for vegetation. id service was consulted. her cefepime was discontinued. the patient will continue a two week course of vancomycin (through , two weeks through last positive blood culture). prior to discharge, the patient's vanco level was greater than 30. her dose was adjusted, and she was instructed to skip a dose when returning home (trough to be measured by vna). upon completetion of the vancomycin, she will initiate treatment with macrobid, which she will continue for one week beyond removal of nephrostomy tubes. dr. of id will oversee this transition. . prior plan was to have left nephrostogram on with potential removal of tube. . # status-post fall: no loc or head strike, likely in setting of hypotension and weakness related to sepsis. only trauma appears to be bilateral knees and perhaps r arm where patient caught herself while falling. she was continued on home dose oxycodone 5mg q6hrs prn pain for her l back/cva tenderness. . # anemia: no evidence of bleeding on exam/history. normal t.bili not indicative of hemolysis. remained stable after 2 units of prbcs. . # elevated inr: elevated at 1.6 at time of icu arrival. no evidence of dic on lab work-up. mild inr elevation may also be due to recent antibiotic use wiping out gut flora and inhibititon of vit k utilization. started on 3 day course of vit k. inr trended to 1.1 at the time of discharge. . # panhypopituitary: secondary to surgery many years ago. on synthroid and prednisone as outpatient for years. given 2 days of stress dose steroids, and then re-started on home prednisone 5 mg po daily dose 04/07. she was continued on home synthroid at home dose 125mcg daily. . # cervical cancer: s/p treatment with chemo and radiation. her last chemotherapy was on , and her last radiation treatment on . . # transitions of care: - vna will check weekly labs prior to follow-up with id (cbc, chem7, vanco trough) - id will oversee transition to macrobid following vancomycin completion - urology will evaluate/manage timing or nephrostomy tube removal medications on admission: bactrim ds for 14 days started on levothyroxine - 125 mcg tablet - one tablet(s) by mouth daily lidocaine-prilocaine - 2.5 %-2.5 % cream - 2.5grams topically to port site as directed as needed for prior to accessing port olanzapine - 2.5 mg tablet - tablet(s) by mouth q6 hours and qhs as needed for anxiety, insomnia oxycodone - 5 mg tablet - tablet(s) by mouth every four (4) hours as needed for pain polyethylene glycol 3350 - 17 gram/dose powder - 1 packet by mouth daily as needed for constipation prednisone - 5 mg tablet - one tablet by mouth daily prochlorperazine maleate - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth every 6 hours as needed for for nausea acetaminophen - (prescribed by other provider) - 325 mg tablet - 1- 2 tablet(s) by mouth every six (6) hours as needed for pain/fever calcium carbonate - (prescribed by other provider) - 200 mg (500 mg) tablet, chewable - 2 tablet(s) by mouth twice a day docusate sodium - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth twice a day magnesium oxide - (prescribed by other provider; dose adjustment - no new rx) - 400 mg tablet - 1 tablet(s) by mouth three times a day omeprazole magnesium - (otc) - 20 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth daily discharge medications: 1. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 2. lidocaine-prilocaine 2.5-2.5 % cream sig: one (1) appl topical once a day: topically to port site as directed as needed for prior to accessing port. 3. olanzapine 2.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for anxiety. 4. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 5. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 6. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 7. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 9. calcium carbonate 200 mg (500 mg) tablet, chewable sig: two (2) tablet, chewable po twice a day. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. vancomycin 750 mg recon soln sig: seven y (750) mg intravenous q 12h (every 12 hours) for 10 days: please continue through . disp:*qs mg* refills:*0* 13. macrobid 100 mg capsule sig: one (1) capsule po once a day: please start on and continue through your appointment with dr. . disp:*30 capsule(s)* refills:*0* 14. outpatient lab work please check vancomycin trough, cbc with differential, and chemistry panel on and . please fax results to dr. at (infectious disease clinic). discharge disposition: home with service facility: critical care systems discharge diagnosis: primary diagnosis: - methicillin-resistant staph aureus bacteremia - urosepsis . secondary diagnosis: - cervical carcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , it was a pleasure taking care of you at . you were admitted to the hospital with an infection in your urine stream and in your blood. you were started on antibiotics for these infections, and you improved dramatically over the course of your hospital stay. you will continue with antibiotic treatment after leaving the hospital as outline below. . please start the following medication after discharge: vancomycin 750 mg every 12 hours through *please do not take your evening dose on the day of discharge (). . please stop the following medications: bactrim magnesium oxide . on (after completing vancomycin), you will begin therapy with an oral antibiotic called macrobid (nitrofurantoin). you will continue with this antibiotic likely until after your nephrostomy tubes are removed. when you follow-up in infectious disease clinic, they will help you determine the ultimate course of antibiotics. . please continue all other medications as they have been prescribed. should you experience any symptoms that concern you after leaving the hospital, please call your oncologist or return to the emergency room. . followup instructions: department: radiology care unit when: friday at 7:00 am building: de building ( complex) campus: west best parking: garage . department: radiology when: friday at 8:30 am building: cc clinical center campus: west best parking: garage . department: infectious disease when: friday at 11:30 am with: , md building: lm campus: west best parking: garage . department: surgical specialties specialty: urologic surgery when: monday at 8:30 am with: , m.d. building: campus: east best parking: garage . department: hematology/oncology when: monday at 11:00 am with: , md building: campus: east best parking: garage you will only see dr. at this appointment since dr. will be on vacation. . procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified severe sepsis hypopotassemia disorders of phosphorus metabolism osteoporosis, unspecified septic shock urinary complications, not elsewhere classified disorders of magnesium metabolism anemia in neoplastic disease methicillin resistant staphylococcus aureus septicemia other artificial opening of urinary tract status secondary malignant neoplasm of other urinary organs surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iatrogenic pituitary disorders malignant neoplasm of cervix uteri, unspecified site 

Answer: The patient is high likely exposed to