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: imipenem/cilastatin sodium / nsaids / aspirin attending: addendum: the patient was transferred from the surgical service to the medical icu to continue care of his medical issues. with respect to these, the following course ensued: 1. renal failure: a tunneled r hemodialysis line was placed on in the or by the transplant surgery team. the following day () the patient was started on hd. he was dialyzed on the 29th, 30th, and 31st. dialysis should continue at rehab three days per week (every other day, ie mwf vs tthsa, etc). vancomycin level should be checked prior to each dialysis, with dosing of 1000mg iv x 1 given for a level of 15 or less. he has 5 days remaining of vancomycin treatment. 2. respiratory failure: we continued to wean the patient's vent, coming down to cpap/ps 8/5 with fio2 of 40%. he contineud on his trach ventilation with nebulization treatment. we began hemodialysis as above to remove excess fluid in hopes to also improve his respiratory status. 3. ?pneumonia: the patient completed a course of levofloxacin for possible pneumonia seen on cxr, although this appeared resolved on subsequent xrs. he no longer requires levofloxacin 4. coag neg staph bacteremia: the patient was continued on vancomycin for a total 14 day course. the day of discharge () is day 10, so this should continue for another 5 days. 5. leg wounds/possible cellulitis: the patient continued to have excellent wound care to his lower extremities. although these were not believed to be infected, they were empirically covered with the vancomycin he was already being treated with for his bacteremia. 6 atrial fibrillation: the patient has afib with a pacemaker. he did not require rate control during his stay, however notably as an outpatient he was on both digoxin 0.125 and cardizem 180qday. digoxin should be held in the setting of his renal function, however if needed for rate control diltiazem may be needed at rehab. 7 dilated cbd and elevated lfts: the patient had an ercp after elevation in his lfts, which showed common bile duct dilation. a common bile duct stent was placed empirically with mprovement in lfts. a pancreatic stent was placed prophylactically to prevent post-ercp pancreatitis. this was removed on repeat ercp on the day prior to discharge. 8. s/p r hemicolectomy: the patient was found to have guaiac positive output in his ostomy. per surgery ,this was to be expected after surgery and was not concerning. his hct remained stable on daily check. his abdominal wound was cared for with wound vac and q3 day dressing changes by the surgical team. chief complaint: transfer from ticu for arf major surgical or invasive procedure: see previous surgery d/c summary history of present illness: 67 yo male with h/o morbid obesity, afib s/p pm placement, cellulitis who has had a complex hospital course. he was originally admitted to on for hyperkalemia to 7.1 with creatinine at that time at his baseline of possibly 1.6. he was treated with kayexalate and his potassium supplements and spirinolactone were stopped, with good resolution of hyperkalemia. during that first admission he was also noted to have le cellulitis, right greater than left. he was treated with imipenem/cilastin and developed a rash on his back, which was thought to be to these antibiotics. he was monitored for several days on this medication with some improvement in the cellulitis. wound was cultured and per report grew myoides, acinetobacter lwoffi, campylobacter violacemum,which were all sensitive to levaquin. upon discharge his abx were chagned to clindamycin and flagyl (started for diarrhea and concern for possible c.diff). of note during that admit he was transfused 2 units prbcs for iron deficiency anemia. he was sent to on . . on patient returned to the hospital with lethargy, diffuse rash sob, and o2 sats 85-86% on 3l. abg on arrival was 7.16/79/222. he was started on bipap and sats improved to the mid to high 90s. pt thinks his rash started while he was at the rehab facility. during the admit his wounds were re-cultured and his abx were switched from clindamycin to levaquin. he was also started on solumedrol and duonebs. due to arf with cr up to 2.9 (per report baselin 1.6) his cozaar was held. he was seen by renal for oliguric renal failure, thought to be atn. additionally inr was 5 on so coumadin was held. . he was transferred to with cellulitis c/b worsening oliguric renal failure, copd exacerbation, and drug rxn (rash) to imipenem. he was initially admitted to the micu for sob, and on cxr was noted to have free air. he then went to the or with dr. who then found that patient had a necrotic r colon. patient had a colectomy w/ end ileostomy amd j-tube placement. he was then transferred to the ticu. pathology from the surgery showed kayexalate crystals. . in the ticu he has recovered well from his operation with a ostomy appliance and a wound vac down to the fascia. his wound vac and appliance need to be changed q3 days by surgery. his main issues include his renal failure which has followed a waxing and course, with periods of improvement (creatinine, uop) followed by worsening. renal has been consulted and is following. he also has wounds on his legs, which were being followed by vascular surgery, and are now being followed by the wound care nurse. he also required levophed as recently as 2-3 days ago for sbp in the 80's. given that his main issue is now medical, he is transferred today to the micu for further care. past medical history: morbid obesity bilateral lymphedema a fib s/p pacer chf cri (creat ~ 3.0) dyslipidemia sleep apnea iron deficiency anemia social history: noncontributory family history: noncontributory physical exam: gen: obese male trached, nad heent: perrla, op clear, mmm, trach in place neck: obese, supple cardio: rrr, nl s1 s2 pulm: difficult to assess vent, scattered wheezes abd: soft, obese, nt, hypoactive bs, diffuse macular as well as non-blanching petechial rash ext: b/l le wrapped, no pedal edema, 2+ dp pulse rle, 1+ dp pulse lle neuro: awake, responding appropropriately to questions, moves all extremities skin:diffuse macular rash on legs, trunk, arms, face pertinent results: labs on arrival: glucose-141* urea n-60* creat-3.4* sodium-139 potassium-3.7 chloride-106 total co2-22 alt(sgpt)-11 ast(sgot)-26 ld(ldh)-163 ck(cpk)-177* alk phos-92 tot bili-0.4 pt-18.2* ptt-35.9* inr(pt)-1.7* wbc-11.8* rbc-3.76* hgb-10.4* hct-32.6* mcv-87 mch-27.6 mchc-31.8 rdw-16.9* plt count-203 - neuts-88.6* lymphs-7.4* monos-2.8 eos-1.0 basos-0.2 labs on day prior to discharge : wbc-10.5 rbc-2.86* hgb-8.2* hct-24.9* mcv-87 mch-28.6 mchc-32.9 rdw-18.6* plt ct-241 glucose-84 urean-92* creat-5.3*# na-139 k-4.2 cl-106 hco3-21* abg type-art po2-85 pco2-43 ph-7.31* caltco2-23 base xs--4 totbili-1.9* from peak of 3.0 alt-32 ast-83* alkphos-575* amylase-67 totbili-7.0* dirbili-5.2* indbili-1.8 lipase-154* ercp : five spot fluoroscopic images were obtained by the gastroenterologist during performance of ercp without a radiologist present. these images are limited by motion artifact and underpenetration. the common duct was cannulated and contrast injected demonstrating mild diffuse dilatation of the common bile duct. no definite filling defects to suggest choledocholithiasis are identified. the final image demonstrates a plastic stent within the lower common duct. by report, a main pancreatic ductal stent was also placed. for further details reference to the gastroenterologist's ercp report of the same date is suggested. ct abd/pelvis : 1. technically difficult examination due to patient body habitus and lack of iv contrast. 2. significant ascites but no focal collection. 3. multiple retroperitoneal and inguinal lymph nodes noted. 4. contrast in the descending colon. has this patient had a recent contrast examination? otherwise may represent a fistula. 5. gallstones. 6. left inguinal hernia containing fluid. 7. pacemaker in situ. 8. old healed rib fractures on right side. 9. ? sponge in between buttocks folds versus decubitus ulcer versus rectal fistula. echo : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular systolic function is normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. brief hospital course: the patient was transferred from the surgical service to the medical icu to continue care of his medical issues. for his hospital course prior to icu stay, please see original dc summary (this is written as an addendum to the d/c summary). with respect to his ongoing medical issues in the micu, the following course ensued: 1. renal failure: a tunneled r hemodialysis line was placed on in the or by the transplant surgery team. the following day () the patient was started on hd. he was dialyzed on the 29th, 30th, and 31st. dialysis should continue at rehab three days per week (every other day, ie mwf vs tthsa, etc). vancomycin level should be checked prior to each dialysis, with dosing of 1000mg iv x 1 given for a level of 15 or less. he has 5 days remaining of vancomycin treatment. 2. respiratory failure: we continued to wean the patient's vent, coming down at his lowest support to cpap/ps 8/5 with fio2 of 40%. at the fdischarge he was on cpap/ps with fio2 of 30%. he continued on his trach ventilation with nebulization treatment. we began hemodialysis as above to remove excess fluid in hopes to also improve his respiratory status. 3. ?pneumonia: the patient completed a course of levofloxacin for possible pneumonia seen on cxr, although this appeared resolved on subsequent xrs. he no longer requires levofloxacin 4. coag neg staph bacteremia: the patient was continued on vancomycin for a total 14 day course. the day of discharge () is day 10, so this should continue for another 5 days. 5. leg wounds/possible cellulitis: the patient continued to have excellent wound care to his lower extremities. although these were not believed to be infected, they were empirically covered with the vancomycin he was already being treated with for his bacteremia. 6 atrial fibrillation: the patient has afib with a pacemaker. he did not require rate control during his stay, however notably as an outpatient he was on both digoxin 0.125 and cardizem 180qday. digoxin should be held in the setting of his renal function, however if needed for rate control diltiazem may be needed at rehab. 7 dilated cbd and elevated lfts: the patient had an ercp after elevation in his lfts, which showed common bile duct dilation. a common bile duct stent was placed empirically with mprovement in lfts. a pancreatic stent was placed prophylactically to prevent post-ercp pancreatitis. this was removed on repeat ercp on the day prior to discharge. 8. s/p r hemicolectomy: the patient was found to have guaiac positive output in his ostomy. per surgery ,this was to be expected after surgery and was not concerning. his hct remained stable on daily check. his abdominal wound was cared for with wound vac and q3 day dressing changes by the surgical team. medications on admission: meds on transfer from ticu: 1. insulin sc 2. albuterol-ipratropium 6 puff ih q4h 3. lansoprazole oral disintegrating tab 30 mg po daily 4. artificial tear ointment 5. levofloxacin 250 mg iv q48h last dose 3/30 or (depending when q48 dosing falls) 6. artificial tears 1-2 drop both eyes prn 7. magnesium sulfate 2 gm / 100 ml ns iv prn mag < 2.0 icu sliding scale 8. calcium gluconate 2 gm / 100 ml ns iv prn ionized < 1.1 sliding scale 9. metoclopramide 10 mg iv q8h 10. epoetin alfa 8000 unit sc qmowefr 11. miconazole powder 2% 1 appl tp prn 12. hydromorphone (dilaudid) 1-4 mg iv q3-4h:prn pain 13. midodrine 10 mg po tid 14. norepinephrine 0.03-0.5 mcg/kg/min iv drip titrate to map >60 15. potassium chloride iv sliding scale 16. heparin 5000 unit sc tid 17. zolpidem tartrate 5-10 mg po hs 18. hydrocerin 1 appl tp to both legs discharge medications: 1. white petrolatum-mineral oil cream : one (1) appl topical (2 times a day). 2. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 3. metoclopramide 5 mg/ml solution : two (2) ml injection q8h (every 8 hours). 4. artificial tear with lanolin 0.1-0.1 % ointment : one (1) appl ophthalmic prn (as needed). 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed). 6. miconazole nitrate 2 % powder : one (1) appl topical prn (as needed). 7. albuterol-ipratropium 103-18 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 8. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 9. zolpidem 5 mg tablet : 1-2 tablets po hs (at bedtime). 10. calcium acetate 667 mg capsule : one (1) capsule po tid (3 times a day). 11. hydromorphone 2 mg/ml syringe : 1-4 mg injection q3-4h (every 3 to 4 hours) as needed for pain. 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. insulin please give according to enclosed slide scale 14. heparin lock flush (porcine) 100 unit/ml syringe : one (1) ml intravenous daily (daily) as needed: 10 ml ns followed by 1ml of 100 units/ml heparin each lumen qday adn prn. inspect site every shift. 15. sodium chloride flush for line care sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 16. vancomycin 1,000 mg recon soln : 1000 (1000) mg intravenous qhd for 5 days: dose if vancomycin level is < or equal to 15. discharge disposition: extended care facility: northeast - discharge diagnosis: coag negative staph bacteremia ischemic colon s/p hemicolectomy with ostomy anaphylaxis to imipenem atrial fibrillation renal failure requiring hd morbid obesity biliary duct obstruction with hyperbilirubinemia s/p stent placement bilateral leg cellulitis discharge condition: trach in place on ventilator cpap/ps and being weaned as tolerated. hd tunneled cath in placen ad tolerating hd. afebrile. afib rate controlled. discharge instructions: please continue all medications as directed. please perform hd three times per week. last hd was day of discharge (). please continue abdominal wound care with vac dressing changed q3 days. please continue to wean vent as tolerated and maintain trach care. please continued chest pt and nebulizers. please maintain standard line care of l hd tunneled catheter line. if the patient developes rapid heart rate consider restarting his diltiazem for rate control of afib (has been on hold as rate has been under control on own). please continue wound care for bilateral lower extremities in order to prevent infection. if you have fever, chest pain, increased infection or other concerning symptoms please call your doctor or come to the emergency room. followup instructions: please call dr. office (surgery) for a follow up appointment in the next 2-3 weeks. if you cannot be followed by a nephrologist at your rehab facility please call our nephrology department for a follow up appointment in the next 2 weeks. md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis non-invasive mechanical ventilation temporary ileostomy temporary tracheostomy endoscopic insertion of stent (tube) into bile duct open and other right hemicolectomy transfusion of packed cells transfusion of other serum endoscopic retrograde cholangiopancreatography [ercp] removal of pancreatic tube or drain endoscopic insertion of stent (tube) into pancreatic duct diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver acquired coagulation factor deficiency unspecified septicemia severe sepsis atrial fibrillation perforation of intestine obstructive chronic bronchitis with (acute) exacerbation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease cellulitis and abscess of leg, except foot long-term (current) use of insulin unspecified sleep apnea septic shock morbid obesity paralytic ileus pressure ulcer, lower back other specified disorders of biliary tract infection and inflammatory reaction due to other vascular device, implant, and graft acute vascular insufficiency of intestine cholangitis other specified antibiotics causing adverse effects in therapeutic use fitting and adjustment of cardiac pacemaker venous (peripheral) insufficiency, unspecified other suppurative peritonitis other lymphedema other anaphylactic reaction 

Answer: The patient is high likely exposed to