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: methotrexate / penicillins / heparin agents attending: chief complaint: shortness of breath, drainage from sternal wound major surgical or invasive procedure: repair of right ventricle laceration and sternal wound debridement reopen sternotomy for right ventricular compression sternal debridement, laparotomy with pedicle omental flap procedure, open jejunostomy tube placement, bilateral advancement skin and subcutaneous chest flaps. split-thickness skin graft to omental flap and sternal wound. measurements 12 x 20 cm with a split-thickness skin graft 12,000 of an inch meshed 1:1.5. 2. preparation of recipient sternal wound by debridement and excision of necrotic skin and subcutaneos tissue and repositioning and securing and preperation of omental flap. tracheostomy tube (percutaneous) history of present illness: this is a 62 year old gentleman who underwent a recent aortic to descending aorta bypass for coarctation of the aorta in of . he had developed hit in the post-operative period and was started on argatroban which was transitioned over to coumadin. he had some serosanguinous drainage at the inferior portion of his sternotomy which had cleared prior to discharge. he now presents with increasing shortness of breath and some stenral instability. there has been some serosanguinous drainage from his wound. past medical history: status-post ascending aorta to descending aorta bypass graft with 18mm gelweave coarctation of the distal arch s/p surgical repair of arch/desc. aorta w/ homograft via left thoracotomy at age 13 bicuspid aortic valve congestive heart failure hypercholesterolemia psoriatic arthritis osteoarthritis asthma sciatica hemorrhoids meckel's diverticulum s/p surgery right lung nodule s/p l2-l3, l4-l5 sacral fusion s/p l subacromial decompression via arthroscopy s/p appendectomy s/p open cholecystectomy s/p r inguinal hernia repair s/p nasal surgery for deviated septum s/p lens implants social history: no tobacco, no etoh. married with 2 children. family history: maternal uncles died in 50's from mi physical exam: on admission: v/s: afebrile, 98% room air, normotensive, 90kg gen: wd/wn, no acute distress, not in discomfort cv: regular rate and rhythm, no murmur, slight rub pulm: crackles appreciated in left base, normal inspiratory effort chest: sternal wound intact, trace serosanguinous drainage, no erythema abd: soft, nt/nd + bs, obese extr: 1+ edema derm: psoriatic lesions neuro: conversant, cn 2-12 grossly intact discharge: vs:t 97 hr 94sr bp 113/56 rr 30 sat 93% 40% trach collar gen: nad neuro: responsive, follows commands, mae resp: coarse, diminished in bases cv: rrr, incision w/skin graft cdi abdm: soft, nt/nabs. feeding tube intact ext: warm, no cce pertinent results: department of for more detailed results-- ] 08:30pm blood wbc-9.8 rbc-3.31* hgb-10.2* hct-30.0* mcv-91 mch-30.7 mchc-33.9 rdw-15.4 plt ct-818* 05:56am blood wbc-8.2 rbc-3.11* hgb-9.4* hct-28.2* mcv-91 mch-30.3 mchc-33.4 rdw-15.4 plt ct-664* 11:45am blood wbc-17.1*# rbc-3.91*# hgb-12.2*# hct-34.8* mcv-89 mch-31.2 mchc-35.1* rdw-14.3 plt ct-213# 01:35pm blood wbc-17.1* rbc-4.93# hgb-15.4# hct-42.9 mcv-87 mch-31.1 mchc-35.8* rdw-14.1 plt ct-226 03:56pm blood wbc-9.1 rbc-3.68* hgb-11.3* hct-31.3* mcv-85 mch-30.7 mchc-36.0* rdw-14.7 plt ct-143* 10:52am blood wbc-13.7* rbc-4.04* hgb-11.9* hct-34.9* mcv-87 mch-29.5 mchc-34.1 rdw-15.0 plt ct-372 02:51am blood wbc-16.8* rbc-3.00* hgb-8.8* hct-26.3* mcv-88 mch-29.2 mchc-33.3 rdw-15.6* plt ct-689* 03:13am blood wbc-8.9 rbc-3.27* hgb-10.2* hct-28.9* mcv-88 mch-31.3 mchc-35.4* rdw-17.2* plt ct-529* 03:01am blood wbc-8.5 rbc-3.22* hgb-9.5* hct-28.7* mcv-89 mch-29.4 mchc-33.0 rdw-17.2* plt ct-517* 03:00am blood wbc-10.3 rbc-3.29* hgb-9.8* hct-29.3* mcv-89 mch-29.8 mchc-33.5 rdw-16.9* plt ct-537* 12:00am blood wbc-11.1* rbc-3.31* hgb-9.7* hct-29.5* mcv-89 mch-29.2 mchc-32.8 rdw-16.6* plt ct-536* 08:30pm blood neuts-68.5 bands-0 lymphs-12.5* monos-5.3 eos-12.9* baso-0.7 08:30pm blood pt-32.0* ptt-32.2 inr(pt)-3.4* 03:21pm blood pt-16.8* ptt-32.1 inr(pt)-1.5* inr: 1.4 02:51am blood ret man-2.3* 08:30pm blood glucose-119* urean-13 creat-1.2 na-133 k-3.9 cl-97 hco3-23 angap-17 05:56am blood glucose-151* urean-12 creat-1.4* na-131* k-3.6 cl-96 hco3-24 angap-15 01:55am blood glucose-145* urean-14 creat-1.0 na-134 k-3.9 cl-109* hco3-19* angap-10 03:25am blood glucose-82 urean-13 creat-0.9 na-133 k-5.0 cl-104 hco3-21* angap-13 10:00am blood k-3.9 12:23am blood glucose-151* urean-24* creat-1.1 na-150* k-3.3 cl-110* hco3-26 angap-17 04:14am blood glucose-143* urean-22* creat-1.1 na-147* k-3.3 cl-110* hco3-27 angap-13 03:00am blood glucose-164* urean-15 creat-0.8 na-143 k-3.7 cl-105 hco3-22 angap-20 12:00am blood glucose-210* urean-16 creat-0.8 na-147* k-4.2 cl-109* hco3-26 angap-16 08:30pm blood ck(cpk)-60 10:58am blood alt-21 ast-52* ld(ldh)-384* alkphos-72 amylase-23 totbili-1.6* 11:33am blood alt-25 ast-53* ld(ldh)-417* alkphos-88 totbili-0.8 09:47am blood alt-17 ast-35 ld(ldh)-257* alkphos-124* amylase-36 totbili-0.6 03:00am blood alt-23 ast-19 ld(ldh)-300* alkphos-121* amylase-109* totbili-0.4 12:00am blood alt-22 ast-27 ld(ldh)-244 alkphos-118* amylase-102* totbili-0.4 10:58am blood lipase-10 02:20am blood lipase-9 09:47am blood lipase-25 09:30pm blood lipase-99* 12:00am blood lipase-129* 10:58am blood albumin-2.1* mg-1.8 09:30pm blood albumin-1.1* 03:00am blood albumin-2.3* calcium-8.2* phos-3.5 mg-2.3 12:00am blood albumin-2.8* calcium-8.4 phos-3.3 mg-2.1 03:56pm blood tsh-6.9* 03:26am blood tsh-6.5* 09:47am blood t4-7.1 t3-97 free t4-1.2 02:30am blood t4-6.6 t3-93 free t4-1.1 03:26am blood t4-7.4 t3-107 11:33am blood cortsol-15.0 06:39pm blood cortsol-29.4* 09:47am blood antitpo-17 08:25pm blood vanco-13.6* 09:34am blood vanco-16.6* microbiology: aortic wound: mrse blood culture: vre urine culture: > 100,000 yeast sputum culture: s. aureus urine culture: > 100,000 yeast catheter tip culture: mrse sputum culture: mrsa subcutaneous fat culture: enterococcus sputum culture: negative urine culture: negative blood cullture: negative stool culture and c. diff: negative radiology: cxr: : the enlarged cardiomediastinal silhouette is unchanged from and , presumably postoperative related changes. the left basilar atelectasis/consolidation is unchanged. small left-sided pleural effusion is unchanged. the pulmonary vascularity is normal in appearance. there is no pneumothorax. there is a left-sided picc line with its tip in stable position in the mid left subclavian vein. abdominal ultrasound: liver is normal in size. no intrahepatic lesions demonstrated. the visualization of the left lobe suboptimal due to the presence of overlying chest wall wound. no intra- or extra- hepatic biliary dilatation. the patient is post- cholecystectomy. no free intraabdominal fluid or upper abdominal collections demonstrated. spleen is normal in size at 10.2 cm. both kidneys are normal in size, the right measures 10.4 and the left 10.2 cm, no hydronephrosis or hydroureter. doppler assessment of the hepatic vasculature shows main portal vein with normal hepatopetal directional flow. the left main and right hepatic veins are patent. cxr: there is again demonstrated a tracheostomy tube, left chest tubes, right picc and a right subclavian central venous catheter in stable position. there is no pneumothorax. there are persistent bibasilar densities, left greater than right, and left retrocardiac opacity. there are unchanged small bilateral pleural effusions, left greater than right. no new opacities are seen. brief hospital course: this is a brief discharge summary for a prolonged hospitalization for this 62 year old gentleman who presented on with sternal wound drainage status-post tube grafting of ascending to descending aorta for coarcation in of . hospital course is summarized by organ systems: from a cardiac surgery standpoint, the patient was noted to have worsening bloody drainage and a fever to 103 on the morning after his evening admission. he was taken emergently to the operating room where sternal wound was opened and a laceration to the right ventricle was appreciated and repaired (please see the operative note of dr. for full details). several hours later that evening he was again returned to the operating room for poor hemodynamics in the icu with evidence of right ventricular compression; hematoma was evacuated and the sternal wound was left open. he was then actively diuresed for several days and returned to the operating room on for omental flap and subcutaneous chest flap closure of his sternal wound (please see the operative note of dr. w/ thoracics surgery for full details); a j-tube was placed during this operation. a vac dressing was left in place during this operation and after significant wound closure, split thickness skin grafts were then harvested and grafted to the wound site (please see the operative note of dr. from for full details). his wound demonstrated appreciable improvement over the next few weeks. jp drains were left in place under his wound, with planned removal by thoracics surgery once there was trace to no output. from a cardiovascular standpoint, the patient required intermittant amiodarone for sinus tachycardia and bursts of afib. during a portion of his hospital course he presented with hypotension (with cause most likely from sepsis, with endocrinologic abnormalities ruled-out) and required pressors, however he was weened off pressors and amiodarone for several weeks prior to discharge. from a pulmonary standpoint, the patient was noted to have bilateral pulmonary effusions and mrsa pneumonia during his hospital course. he also required intermittant nebulizors. despite antibiotic treatment for his pneumonia, he failed 2 extubation attempts. he therefore underwent percutaneous tracheostomy on (please see the operative not of dr. for full details). he was eventually weened to trach-mask ventilation via his trach tube. from a neurologic standpoint, the patient required sedation for an extensive period of time due to his intubation. once extubated, he required intermittant ativan to counter withdrawal symptoms from being on a versed drip. by the time of his discharge he demonstrated marked improvement in alertness with ability to communicate with staff via alphabet cards and ability to fully comprehend staff members. he was seen by endocrinology for elevated tsh levels but was felt to have subclinical hypothyroidism and had normal t4 levels. from a hematologic standpoint the patient was admitted with a known diagnosis of heparin-induced thrombocytopenia, and he had been on coumadin since early . while he was in the peri-operative period for his various procedures he was maintained on an argatroban drip but this was eventually discontinued and transitioned to coumadin, with near-therapeutic levels by . his goal is to continue on coumadin for hit for approximately 2-3 months. from an infectious standpoint the patient had a fever to 103 on hospital day 2 and was found to have infectious drainage from his mediastinal wound growing mrse. he also had vre bacteremia, yeast infections in his urinary tract, and mrsa in his sputum throughout his hospital course. infectious disease consultation was obtained early in his hospital course with appropriate treatment of these infections; eventually he had pan-negative cultures prior to discharge. he will complete a 28-day course of linezolid for his vre bacteremia, mrsa pneumonia, and mrse woudn infection oon . from a gi standpoint, the patient demonstrated poor oral intake given his comorbidities and a j-tube was placed at the time of his wound closure operation of . he was on goal tube feeds for several weeks prior to discharge. his albumin levels were normal prior to discharge and prevacid was used for stress ulcer prophylaxis. at time of discharge, the patient was afebrile for over 24 hours, tolerating goal tube feeds, communicating with staff, and stable from a cardiovascular/pulmonary standpoint. a rehab facility with vent-assistance was found and he was discharged with planned follow-up with cardiac and thoracic surgery. all questions were answered to the satisfaction of himself and his proxy prior to discharge. medications on admission: methorexate 7.5 mg po qwednesday, vistaril 25 mg 5x/day, dovonexzonolon topically qdaily dovonex topically qdaily clindamycin topically qdaily singulair albuterol serevent flovent elavil 10 mg po qdialy quinine 325 mg po qhs flexeril lipitor 10 mg po qdaily aspirin lopressor 25 mg po bid remicaid 700 mg po q6 weeks discharge medications: 1. acetaminophen 500 mg capsule sig: capsules po q4h (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 4. atorvastatin 10 mg tablet sig: one (1) tablet po hs (at bedtime). 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal qod (). 7. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 8. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 9. fluticasone 110 mcg/actuation aerosol sig: four (4) puff inhalation (2 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 11. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 12. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours). , completion of 28 day course] 13. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 14. albuterol sulfate 0.083 % solution sig: one (1) inhalation q4h (every 4 hours) as needed. 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours). 16. potassium chloride 20 meq packet sig: one (1) packet po prn (as needed) as needed for k<4.0. 17. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 18. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: five (5) ml po q4-6h (every 4 to 6 hours) as needed. 19. warfarin 5 mg tablet sig: one (1) tablet po once (once) for 1 doses: titrate to goal inr 2-2.5. 20. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 21. calcium gluconate 2 gm / 100 ml d5w iv prn free cal <1.12 to run over 1 hr. 22. magnesium sulfate 2 gm / 100 ml d5w iv prn mg <2.0 23. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 24. dextrose 50% 12.5 gm iv prn glucose < 60 recheck glucose q 30 minutes until glucose > 100 25. metoclopramide 10 mg iv q6h:prn nausea/vomiting 26. furosemide 40 mg iv tid 27. haloperidol 1 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 28. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 29. erythromycin 5 mg/g ointment sig: 0.5 ophthalmic qid (4 times a day): in ou. 30. clindamycin phosphate 1 % solution sig: one (1) appl topical daily (daily). 31. calcipotriene 0.005 % cream sig: one (1) appl topical (2 times a day). 32. doxepin 5 % cream sig: one (1) application topical daily (): for psoriasis. 33. sliding scale insulin (regular) as needed (check q6h fingersticks) discharge disposition: extended care facility: discharge diagnosis: primary: sternal wound dehiscence with laceration of right ventricle secondary: heparin induced thrombocytopenia, failure to thrive, ventilatory-dependence, vre bacteremia, mrse aortic infection, mrsa pneumonia, urinary tract infection, hyperlipidemia, chronic afib, mental status changes, psoriatic arthritis discharge condition: tolerating tube feeds. ventilating via trach-mask. communicating via commands. good pain control. hemodynamically stable. discharge instructions: take all medications as prescribed. no lifting > 10# for 2 months. no creams, lotions or powders to any incisions. tube feeding via j-tube. the patient may shower, no bathing for 1 month. followup instructions: follow-up with dr. upon discharge from rehab () follow-up with dr. upon discharge from rehab dr. (cardiologist) is no longer seeing outpatients, you can follow up with dr. , dr. or dr. at cardiology procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery extracorporeal circulation auxiliary to open heart surgery parenteral infusion of concentrated nutritional substances other enterostomy diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances atrial cardioversion reopening of recent thoracotomy site temporary tracheostomy other skin graft to other sites local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] attachment of pedicle or flap graft to other sites advancement of pedicle graft excisional debridement of wound, infection, or burn injection or infusion of oxazolidinone class of antibiotics application of pressure dressing infusion of vasopressor agent other repair of heart and pericardium diagnoses: unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia severe sepsis candidiasis of other urogenital sites cardiac complications, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins disruption of internal operation (surgical) wound infection with microorganisms without mention of resistance to multiple drugs methicillin susceptible pneumonia due to staphylococcus aureus infection and inflammatory reaction due to other vascular device, implant, and graft congenital insufficiency of aortic valve other specified hypotension hemorrhage, unspecified coarctation of aorta (preductal) (postductal) acute pericarditis, unspecified infection and inflammatory reaction due to cardiac device, implant, and graft laceration of heart with penetration of heart chambers without mention of open wound into thorax 

Answer: The patient is high likely exposed to