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: proxy / caffeine / butalbital / barbiturates / xanthines attending: chief complaint: septic shock major surgical or invasive procedure: tunnelled line placement by ir history of present illness: 71 yo f with dementia, esrd on hd, respiratory failure s/p trach, s/p peg, copd, recurrent aspiration pna, and hx of c.diff colitis is transferred from the rehab macu after having two hypotensive/unresponsive episodes during hd. rather than take fluid off, they gave the patient 500 cc. per the patient's son, the patient has been having difficulties for the past nine weeks, with delerium that finally resolved after adding phosphate binders, correcting lyte (hypercalcemia, hyperpphos) abnormalities, and d/c'ing sedating medications. per rehab records, she recently had recurrent c diff, and was treated with zosyn for pna with cxs + for providencia stuartii, psuedomonas, and citrobacter. she appeared to recover when she was noted about 1 week prior to admission be increasingly hypotensive with altered mental status. she had blood and c diff cxs from which were negative. sputum cultures again grew citrobacter and pseudomonas. she was started on levaquin for citrobacter (pseudomonas was presumed to be a colonizer) but she was noted to have worsening resp status with increasingly purulent sputum. on her antibiotics were changed to tobramycin and cefepime. her wbc has continued to rise, she had an episode of atrial fibrillation, and then the above mentioned episodes at hd. . in the ed, patient's blood pressures were initially in the 90's - 100's and the patient's mental status was at baseline per her son. count returned at 20.1 and her cxr came back as having bl infiltrates concerning for multifocal pna vs aspiration. she then began to drop her pressures into the 60's systolic. a code sepsis was called. she received 2 liters of fluid and was started on peripheral levophed. a central lines was placed and her initial cvp was 13 and her lactate was 1.5. she appeared to be having significant oral secretions and de-satting down to the 80's so she was placed on the ventilator. she was started on vancomycin, zosyn, azithromycin and admitted to micu for further work-up and management. . per her son, at baseline she is able to hold a coherent conversation although she has some chronic deficits from her previous cva's including frequent altered mental status with infections or lyte abnormalities, finding it difficult to explain where her pain is in her body, and being easily overstimulated (lights, sounds.) she had some diarrhea at rehab today, and again in the ed, and one episode of vomiting this am. her baseline temp is 97.8 and she rarely gets fevers when infected. past medical history: #. esrd on hd of unclear etiology. ? d/t chronic pyelo and uncontrolled htn. #. respiratory failure s/p trach in , vent dependent until when she was successfully weaned off #. copd #chronic pleural effusions #. recurrent aspiration pna #. pvd, s/p r cea, s/p bilateral iliac stents and gangrene of toew bilaterally and autoamputating #. htn #. hypothyroidism #. h/o gi bleeding #. chf no previous echo here, so unclear #. h/o cholesterol emboli syndrome #. paroxysmal af # anemia # s/p multiple embolic cva # dementia # adenocarcinoma of the colon s/p resection in # s/p peg # h/o mrsa colonization # hx of pseudomonas colonization # h/o vre infection # c.diff colitis social history: # personal: lives at rehab. divorced. three adult children. # tobacco: former smoker. 3 packs per day x 13 years. # alcohol: occasional past use. family history: # siblings: mi in 60s. schizophrenia. physical exam: vs: t: bp: 114/54 p: 66 rr: o2 sat: 100% gen: lying in bed, nad heent: perrl, cloudy cornea, mouth open with dry tongue. no obvious op lesions neck: trach in place cv: rrr, nl s1 and s2, no m/r/g pulm: cta bilaterally, no wheezes/rhonchi/crackles. abd: soft, grimaces on palpation, mildly distended, active bowel sounds. no hepatosplenomegaly ext: warm, no edema of les, no rashes, lidoderm patch on feet bilaterally, dry gangrenous toes bilaterally and auto-amputated toes on l. r great toe looks dry and auto-amputating. no signs of infection in any toes, however. neuro: awake, opens eyes spontaneously, but does not follow any commands. uncooperative with exam. pertinent results: findings: a single frontal view of the chest labeled "pcxr upright at 15:00 p.m." excludes the uppermost portion of the left lung apex. a tracheostomy tube is in unchanged position. the left-sided hemodialysis catheter again terminates at the cavoatrial junction. cardiomegaly is unchanged. perihilar opacities, probable small bilateral pleural effusions, and kerley b lines are consistent with mild chf. in addition, airspace opacities in the right upper lobe abutting the major fissure and opacity in the right lower lung field may represent pneumonia or aspiration. no pneumothorax is evident. atherosclerotic calcifications are again noted along the thoracic aorta. a tube overlying the left upper abdomen is again seen. no rib fractures are seen. impression: right-sided opacities may represent multifocal pneumonia versus aspiration. these findings are superimposed on underlying mild chf. brief hospital course: a/p: 71 yo f with dementia, cvas, esrd on hd, chronic respiratory failure s/p trach, s/p peg, copd, recurrent aspiration pna, and recent hx of c diff colitis transferred from rehab macu with septic shock. . 1) septic shock: patient has infiltrates on cxr concerning for pna, infectious vs recurrent aspiration pna. at rehab grew out resistant pseudomonas and citrobacter in her sputum. she was being treated for citrobacter and pseudomonas pneumonia with vancomycin, zosyn, and gentamycin. when her cultures from rehab returned, the pseudomonas was only intermediate sensitive to the gentamycin and she was switched to vanc, zosyn, and amikacin which were dosed at various levels as her kidney function fluctuated. a sputum sample sent here grew out pseudomonas which was sensitive to gentamycin and amikacin. patient was left on the amikacin, dosed by level. additonal possible sources for infection included her multiple lines. she had a picc lines placed at rehab on and a tunneled line catheter, which proved to be non-functioning and was removed. cultures were sent from all her lines and were all negative. she is anuric. she had no other localizing signs or symptoms. she initially required levophed and vasopressin, titrated to systolic blood pressure rather than maps given her chronically low diastolic blood pressure. she was extremely difficult to wean so she was started on stress dose steroids on . she came off both pressors by and stress dose steroids were d/c'd on . given her obvious pneumonia, lack of signs of local infection, and negative blood cultures from her lines, her picc line was left in place. she recovered from her shock and tolerated fluid removal by intermittent hd prior to discharge. her antibiotics will be continued until . . 2) respiratory failure: patient has chronic trach but has not been vent dependent since prior to this admission. as noted above she was vented in the ed for thick yellow secretions and hypoxia to the 80's. she continued to have thick pale yellow secretions while on the vent. she was placed on standing albuterol and atrovent nebs, and qvar for her history of copd. she received aggressive pulmonary toilet. . 3) esrd: pt is on m-w-f hd schedule but was not able to receive hd given her pressor-dependent septic shock. renal was consulted. cvvh was schedule to be initiated on but was post-poned when it was discovered that her tunneled dialysis catheter was not working. the old line was removed and a new one was placed by ir on . the line placement was complicated by some bleeding at the insertion site. that day, patient's ptt was greater than 150 depite not receiving any systemic heparin. the draw was repeated three times, two line draws and a peripheral stick with peristently elevated ptt. the patient received a one time dose of ddavp and the bleeding at the line site eventually resolved with additional sutures and a fibrin injection. cvvh was initiated late in the evening of . after her shock improved, she tolerated intermittent hd last on . she will resume her prior m-w-f schedule. she was discharged above her dry weight however she was requiring minimal ventilatory support. she can be re-assessed daily should she need additional ultra-filtration sessions. . 4) bradycardia/atrial fibrillation: previous ecg from shows normal rate. ecg shows sinus brady with 1st degree block. her dignoxin level was checked multiple times and remained sub-therapeutic. nevertheless, it was held given her bradycardia with rates in the 40's but dipping transiently as low as the 30's. an echocardiogram was performed which showed preserved ef. the etiology of her bradycardia was unclear. on she was noted to be in atrial fibrillation with rates to the 80's. her asa was increased from 81 mg to 325 mg po daily. her digoxin was discontinued as she remained rate controlled without it. . 5) g-tube fell out: on arrival to the unit patient's g-tibe was noted to be out and lying at her side. a foley catheter was placed and surgery was consulted. patient received her tube feedings and po medications through the foley cathter without complication. the g-tube was changed during her admission. . 6) anemia: patient has chronic macrocytic anemia. b12 and folate levels were normal. her hct drifted downwards until on it had trended down to 22.7. as the patient was actively oozing from the site of her new hd catheter, she received one unit of prbc with an appropriate rise in her hct. she has been relatively stable at ~ 26 since that time with no further signs of active bleeding. . 7) hypothyroidism: continue synthroid which was changed to iv. this can be converted to g-tube administration once her mid-line is removed. . 8) pvd: followed by vascular surgery at rehab. patient has dry gangrene of toes and auto-amputating. per son, problem with infection. lidoderm patches were applied to her feet. . 9) fen: - tf via g-tube - replete lytes prn . 10) ppx: - heparin sc for dvt prophylaxis - ppi . 11) communications: , and hcp, (cell) . 12) code: no compressions, no shocks. chemical code okay. - confirmed with son (hcp)on . 13) access: midline (placed at hr ), tunnelled hd cath (placed ) . 14) dispo: transfered to macu at senior life 15) ethical considerations: pt seems very uncomfortable, resists nursing care, usually noncommunicative during hospital course but did mouth words to the nurses and doctors. her only communications were clearly mouthing "i want to die" and "help me." son argues that she doesn't mean that, or that she only says those things when she is sick. discussed with ethics and social work. medications on admission: 1. hydromophone 0.75mg q2h/prn during hd sessions only 2. vancomycin 125mg qid gt 3. oxycodone 2.5mg q6h/prn gt 4. benadryl 25mg /prn gt 5. benadryl 25mg qhs gt 6. tums 650mg po qid 7. colace 100mg /prn gt 8. digoxin 0.125mg every other day gt, last dose given today at the rehab 9. mucomyst 200mg tid inh 10 tylenol q6h/prn gt 11. albuterol 2 puffs q6h/prn inh 12. synthroid 125 mcg daily gt 13. aspirin 81mg qday gt 14. combivent 6 puffs q6h inh 15. lactinex 1 tab gt 16. prilosec 20mg gt 17. reglan 10mg tid gt 18. lidoderm patch top daily 19. lactobacillus 1 tab 20. epogen at hd discharge medications: 1. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 2. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day) as needed. 3. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation qid (4 times a day). 4. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection (2 times a day). 5. nystatin 100,000 unit/ml suspension : five (5) ml po bid (2 times a day). 6. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed. 7. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed: apply to perineal area. 10. albuterol 90 mcg/actuation aerosol : 2-15 puffs inhalation q6h (every 6 hours). 11. albuterol 90 mcg/actuation aerosol : 2-15 puffs inhalation q2h (every 2 hours) as needed for sob, wheeze. 12. beclomethasone dipropionate 80 mcg/actuation aerosol : one (1) puff inhalation (2 times a day). 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical 3x/week (tu,th,sa): apply to intact skin of right foot. 14. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical 3x/week (tu,th,sa): apply to intact skin of left foot. 15. aspirin 325 mg tablet : one (1) tablet po daily (daily). 16. insulin regular human 100 unit/ml solution : 0-10 units injection asdir (as directed). 17. levothyroxine 200 mcg recon soln : one (1) recon soln injection daily (daily). 18. fentanyl citrate (pf) 50 mcg/ml solution : 0.5-1 ml injection q4h (every 4 hours) as needed for pain. 19. amikacin 250 mg/ml solution : 1.6 ml injection qhd (each hemodialysis): last dose on . 20. piperacillin-tazobactam 2.25 gram recon soln : one (1) recon soln intravenous q12h (every 12 hours): last dose on . discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: 1)sepsis secondary to ventilator associated pneumonia 2)respiratory failure 3)end stage renal disease secondary diagnoses: 1)atrial fibrillation 2)anemia 3)hypothyroidism 4)peripheral vascular disease discharge condition: stable. mouthing words. moving all 4 extremities. discharge instructions: 1)you were admitted to the hospital with an infection, likely in your lungs. you are currently on antibiotics for 2 weeks. 2)please take all medications as listed in the discharge instructions. 3)please attend all appointments as listed below. please schedule an appointment with your primary care physician within few weeks after being discharged from the hospital. 4)if you experience any fevers, chills, chest pain, shortness of breath, dizziness, or any other concerning symptoms please return to the emergency room. followup instructions: provider: , md phone: date/time: 2:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis arterial catheterization injection of antibiotic replacement of gastrostomy tube diagnoses: end stage renal disease abnormal coagulation profile unspecified pleural effusion unspecified septicemia severe sepsis unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation peripheral vascular disease, unspecified other persistent mental disorders due to conditions classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified cardiac dysrhythmias pneumonia due to pseudomonas septic shock personal history of malignant neoplasm of large intestine personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits other postprocedural status personal history of noncompliance with medical treatment, presenting hazards to health other and unspecified complications of medical care, not elsewhere classified aphasia gastrostomy status chronic respiratory failure tracheostomy status unspecified deficiency anemia 

Answer: The patient is high likely exposed to