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: heparin agents / ceftriaxone attending: chief complaint: s/p fall major surgical or invasive procedure: left hip dynamic hip screw (open reduction and internal fixation). history of present illness: although the pt was responding to questions, a complete history was difficult to obtain. the following hpi was obtained from chart biopsy and son. . 81 yo chronically ill female with mmp, resident at nursing home who presented to hospital after falling out of bed. the pt normally requires assist from two people for repositioning. on , the pt was trying to get up unassisted and fell out of bed onto her left side. the pt was biba to and was found to have a left proximal humerous, left proximal femur, left supracondylar knee fracture, and left rib fracture. the pt was given dilaudid iv and fentanyl for pain control with good success as rn report. the ecg at nw was nsr at 70, lad, nml interval, rsr' in v1, twi in iii and f. . currently patient reports some back pain but is unable provide any history about the fall or her medical history. per son, pt cannot give much history when in pain for sick. she has very littel functional capcity only to and from wheelchair with assistance. he denies any hx of mi or chest pain, but she does have pain all over all the time from her ra. past medical history: 1) felty's syndrome (ra, splenomegally, granulocytopenia), anticardiolopin ab, multiple dvts, pes s/p ivc filter many years ago (currently not anticoagulated due to fall risk). 2) cryptogenic cirrhoisis with portal htn and esophageal varices (no etoh hx) and hx of large gi bleed 3) osteoporisis long term prednisone use, and resultant multiple fractures 4) copd on 2l home o2 but only for the past year since at 5) s/p cva with residual aphasia 6) "dementia (though daughter denies this) 7) hypothyroidism, 8) h pylori 9) s/p tkr social history: lives at nursing home she can get up to wheelchair with assistance, only minimal activity, no shortness of breath, dnr/dni family history: non-contributory physical exam: vital signs: tc: 98.7, tmax: 100.1 bp: 100/60 (range: 90-124/60-72) hr: 100 (range: 100-120) rr: 24 sao2: 97% 2l, fs: 120-136 i/o: npo/465 . physical examination: gen: awake, alert, responds to commands and questions appropriately, however unable to give full history heent: perrl, eomi, op with dried blood/crusting, dry mm chest: ctab (difficult to appreciate due to poor resp effort bilaterally) cv: tachycardic but regular rhythm, s1, s2 difficult to appreciate, no murmurs abd: soft nt/nd, +bs ext: wwp, lle in immobilizer and externally rotated, ?shorter lle, no edema, echymosis in left arm and leg, moving all four extremities including toes. pt +1 bilaterally and + left radial artery neuro: grossly intact to sensation bilaterally. pertinent results: 08:45pm wbc-10.7 rbc-3.04* hgb-9.1* hct-26.6* mcv-87 mch-29.8 mchc-34.1 rdw-15.1 08:45pm glucose-131* urea n-18 creat-0.7 sodium-142 potassium-4.5 chloride-110* total co2-23 anion gap-14 08:45pm calcium-7.5* phosphate-3.5 magnesium-1.7 ekg at 12:27: nsr at 90, lad, nml interval, rsr' in v1, v2, poor r wave progression, twi in iii and f. . ekg at 2:07: nsr at 115bpm, lad, rsr' in v1, v2, +pvc, no rwave progression, q's in v4-6 new from ekg and from ekg . lle plain film : comminuted fracture of the intertrochanteric region of the left proximal femur. . pelvis ct : 1. comminuted oblique intertrochanteric fracture of the left proximal femur with slight varus angulation and an associated hematoma tracking along the left hamstring musculature. both hip joints are otherwise preserved. 2. multiple chronic fracture within the left subcapital femur, left symphysis pubis, right inferior pubic ramus, and the intertrochanteric right femur (with placement of a dynamic compression screw). 3. healing stress fracture of the right sacral ala. . . cxr : a focal opacity in the mid left lung is better defined on today's exam. in addition, there is likely a developing opacity in the right lower lobe. multiple healing right posterolateral rib fractures are identified. the heart is normal size and the mediastinal is remarkable for a calcified and tortuous aorta. no pulmonary edema or pleural effusions identified. calcified gallstones and previous spine surgery again identified. impression: likely developing multifocal pneumonia. . cta chest 1) no acute pulmonary embolus 2) atelectasis of much of the left lower lobe with extensive mucous debris vs. aspirated content within the right and left lower bronchi and their segmental branches.this should be addressed with respiratory therapy. 3) moderate centrilobular emphysema. mild subpleural honeycombing in the mid to lower zone due to background of interstitial lung disease.this distribution may be due to connective tissue disease if there is a history of this (felty's is mentioned in the request details).other possibilities would included interstitial pulmonary fibrosis or drug reaction depending on the clinical history. 4) cholelithiasis . left humerus film : impacted humeral head fracture. of note, this appears to have been present on chest x-ray dating back to . . . microbiology: 1) sputum : mrsa . 2) catheter tip : proteus mirabilis ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 8 s cefepime-------------- 4 s ceftazidime----------- 16 i ceftriaxone----------- <=1 s cefuroxime------------ 8 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- s levofloxacin---------- =>8 r meropenem------------- 0.5 s piperacillin---------- 64 i piperacillin/tazo----- 32 i tobramycin------------ 8 i . 3) sputum : proteus mirabilis ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 8 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 4 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ 2 s . 4) urine cx : pseudomonas aeruginosa cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem------------- 2 s piperacillin---------- 8 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s brief hospital course: ms. is an 81 yo woman with hx of felty's syndrome, osteoperosis, dementia who presented after falling out of bed at her nursing home with resultant left sided fractures. . she was found to have a comminuted oblique intertrochanteric fracture of the left proximal femur. the ortho team evaluated her initially and recommended orif of the hip fracture. while undergoing pre-op by ortho for surgery, the patient developed hypoxia secondary to aspiration pneumonia. initially, she was placed on levofloxacin, flagyl, and vancomycin. later, she became progressively more hypoxic and hypotensive. she was bolused and given stress dose steroids for hypotension. the medical team at that time had a discussion with patient's family, and because her prognosis was poor, the decision was made to change her status to comfort measures only. the family wanted to discontinue all medications except for the antibiotics and pain control/comfort meds. . about 48 hours later, the medical team noted marked clinical improvement. the patient was more alert, blood pressure was improved, and oxygen requirement decreased. her status was changed back from cmo to dnr/dni. ortho began to evaluate her again for possible surgery. she was taken on for left hip dynamic hip screw (open reduction and internal fixation). after surgery, she remained intubated and was admitted to the micu electively for weaning from the ventilator. pressors were also weaned. she was eventually found to have mrsa and pseudomonas in her sputum, as well as proteus in her urine. her femoral line was also pulled and proteus grew from tip culture. vancomycin was continued for the mrsa in her sputum, and meropenem was started for pseudomonal and proteus coverage. . she was successfully extubated on and was maintatining o2 saturation well on 70% shovel mask. she was trasferred from the micu to the general medicine service on . after transfer to the floor, she initially became hypoxic to the mid-80's, which resolved after receiving lasix and nebulizers. her course was relatively uncomplicated over the next several days. o2 saturation remained in the mid-90's on 70% shovel mask, and diuresis was continued daily since she was fluid overloaded peripherally. her o2 was weaned to 50% shovel mask. . on , the patient became acutely hypoxic and hypotensive (sbp=70). she also had a bloody bowel movement. she was given an ivf bolus and nebulizers. oxygen requirements again increased to 70% shovel mask. at the time, the covering physicians updated the health care proxy with the changes in her condition. the patient's family decided to change her status from dnr/dni to cmo given her poor prognosis, and poor quality of life. most medications were discontinued and the patient was made comfortable. the palliative care service was consulted. another family meeting was held with the health care proxy (), and the patient's daughter () on . the family wanted her to return to the nursing home that she had come from, so the decision was made to wean her o2 to a level that the nursing home would accept her on. the family was in agreement on this descision, and reiterated that they wanted her to be comfortable. they felt that her quality of life was poor, and did not want to prolong her course. the patient was weaned to 4l nc and remained stable and very comfortable. o2 saturation was 95% on 4l nc. she was discharged to her nursing home with hospice care on . . . other issues managed on this admission: . thrombocytopenia: the patient has a history of heparin induced thrombocytopenia. her platelets dropped slightly while in the micu just before being transferred to the floor. it is not clear why this happened. her platelet levels were followed and remained stable. she was continued on fondaparinux for dvt prophylaxis. . elevated liver enzymes: her alk phos and total bili were slightly elevated throughout her admission. this was thought to be secondary to cholestatsis due to gallstones. a cxr from early in her hospital course showed gallstones. her transaminases remained stable, and no intervention was necessary. . osteoporosis: she was continued on calcium carbonate and vitamin d . hypothyroidism: she was continued on synthroid. . rheumatoid arthritis: she received stress dose steroids while in the micu, and then tapered back to prednisone 10mg po daily. medications on admission: allergies: pcn and heparin . medications at nursing home: oxycodone prn albuterol ne albuterol neb prn actonel 35mg qweek vitamin d 800units/day aldactone 75mg qd bumex 2mg qd zoloft 25mg qd asa 81mg qd levothyroxine 200mcg/day prednisone 10mg qd folic acid 1mg qd lidoderm patch tears fovent ipratropium nebs tums 500mg tid colace 200mg qhs fentanyl patch 100mcg/q72hrs enbrel q25mg sq twice weekly-(qtues/fri) tylenol prn pain . meds here: 1000 ml lr @50c/hr magnesium sulfate 2 gm / 100 ml d5w iv once acetaminophen 325-650 mg po q4-6h:prn metoprolol 5 mg iv once rapid afib albuterol 0.083% neb soln 1 neb ih q6h:prn metoprolol 25 mg po bid dolasetron mesylate 12.5 mg iv once morphine sulfate 1 mg iv q4h:prn insulin sc (per insulin flowsheet) discharge medications: 1. fentanyl 100 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). disp:*10 patch 72hr(s)* refills:*0* 2. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 3. docusate sodium 150 mg/15 ml liquid sig: tab po bid (2 times a day) as needed for constipation. 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd () as needed for pain. 5. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 7. morphine concentrate 20 mg/ml solution sig: 5-10 mg po q2h:prn. disp:*qs mg* refills:*0* 8. lorazepam 2 mg/ml concentrate sig: 0.5-2 mg po q2h (every 2 hours) as needed. disp:*qs mg* refills:*0* 9. levsin/sl 0.125 mg tablet, sublingual sig: one (1) tab sublingual every four (4) hours as needed for as needed for secretions. disp:*120 tab* refills:*0* 10. atropine 1 % drops sig: four (4) gtts ophthalmic every four (4) hours as needed. disp:*qs gtts* refills:*0* discharge disposition: extended care facility: of discharge diagnosis: 1) left hip fracture 2) aspiration pneumonia 3) urinary tract infection 4) central venous catheter infection 5) thrombocytopenia 4) discharge condition: stable discharge instructions: please administer medications as prescribed. call patient's primary care physician if any issues or refills of medications needed. followup instructions: please call patient's primary care physician if follow up after discharge is desired. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube percutaneous [endoscopic] gastrostomy [peg] open reduction of fracture with internal fixation, femur diagnoses: thrombocytopenia, unspecified pneumonia due to other gram-negative bacteria urinary tract infection, site not specified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol portal hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction infection and inflammatory reaction due to other vascular device, implant, and graft closed fracture of one rib hypovolemia hyperosmolality and/or hypernatremia esophageal varices in diseases classified elsewhere, without mention of bleeding accidental fall from bed accidents occurring in residential institution diastolic heart failure, unspecified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site pseudomonas infection in conditions classified elsewhere and of unspecified site closed fracture of intertrochanteric section of neck of femur other closed fracture of upper end of humerus felty's syndrome 

Answer: The patient is high likely exposed to