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: patient recorded as having no known allergies to drugs attending: chief complaint: acute on chronic renal failure major surgical or invasive procedure: intubation, extubation placement of nephrostomy tube on left and a stent of right ureter irrigation and debridement of right wrist history of present illness: 79yom with h/o osa, cad s/p mi and cva, diastolic chf admitted to with sepsis secondary to klebsiella bacteremia, admitted again on to urology service from rehab with acute renal failure, transferred to micu with mrsa bacteremia, arf, and respiratory failure. . patient was admitted with sepsis due to klebsiella bacteremia. source of klebsiella infection was not known, but was thought to be from pneumonia seen as retrocardiac opacity on cxr. urinalysis was negative at that time. he was intubated during that admission for airway protection and hypercarbic respiratory failure. although he has osa, he is not a co2 retainer. he was discharged to to complete at 14day course of levofloxacin, to which the klebsiella (from culture at hospital) was sensitive. during his initial presentation he did develop arf with creatinine up to 2.8 from baseline of 1.7-1.9. creat returned to baseline during the hospitalization. it rose to 2.0 prior to discharge after ace-i was restarted. . he was transferred to ed after two days of intermittent right sided abdominal pain, decreased urine output, anorexia, and temp spike to 101. according to the patient's wife, he did not feel himself soon after admission to rehab, refusing to eat, being lethargic and unwilling to participate in rehab activity. in the ed patient found to have arf with creat 7.3, 5.1. ct showed right uvj stone, right perinephric stranding, left ureteral stone, and hydronephrosis. he was admitted to urology service and underwent left percutaneous nephrostomy tube placement. he was also found to have uti and was started empirically on vanc/levo/ceftriaxone. urine culture and blood cultures (4/4 ) grew mrsa, and ctx/levo were discontinued . despite nephrostomy tube placement, patient continued to have ongoing oliguric renal failure, which renal felt was due to persistant obstruction vs atn. he was not hemodialyzed. . on he underwent right ureteral stent placement, retrograde pyelography, and removal of stones. he remained intubated post-operatively. on - pt also complained of right wrist pain/swelling and subsequently was found to have septic wrist. this was irrigated and debrided on . cultures positive for mrsa. on , pt was extubated. on , pt transferred to cc-7a. reported feeling weak. denied ha, dizziness, chest pain,palpatations, sob, cough, abdominal pain, constipation, diarrhea, edema. past medical history: cva - with residual right-sided weakness post-concussive syndrome osa - on 2l nc during day and night; refused home cpap cad - s/p mi in 3 yrs ago chf - diastolic dysfunction anemia - egd with gastritis, colonoscopy with diverticulosis depression s/p right shoulder surgery s/p knee replacement s/p bilateral nephrostomy tube placement social history: he lives with his wife; daughter lives downstairs. tob: h/o cigarrette smoking, quit 22yrs ago etoh: denies family history: h/o prostate cancer and hemorrhagic stroke son d. mi at 50yrs broth d. complications of tiidm physical exam: vs t p bp rr o2 sat gen- obese male, lethargic, nodding off during exam, nad heent- at, nc, perrla, eomi, sclera anicteric, mmm, oropharynx clear neck- large neck, no jvd or lad cor-rrr, no mgr lungs- coarse breath sounds-upper airways, posteriorly cta b/l abd- obese, nontender, nondistended, + bs, no hsm or masses, nephrostomy site-no erythema, induration or oozing from site extrem- right wrist wrapped in bandage-clean/dry/intact, no edema of lower extremeties neuro-cn grossly intact, sensation intact, strength diminished on r side-both upper and lower . pertinent results: imaging: post-extub cxr: endotracheal tube has been removed. feeding tube and left picc line remain in place. cardiac and mediastinal contours are stable. left lower lobe atelectasis is slightly improved. moderate left effusion is unchanged echo: the left atrium is mildly dilated. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricle may be mildly dilated. right ventricular systolic function is normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. ct abd/pelvis 1. status post left nephrostomy. new 1.2-cm oval-shaped focal density, which may be related to recent nephrostomy. persistent left ureteral stone and right obstructing uvj stone, measuring 3 mm with hydronephrosis and hydroureter. no obstructing right renal stones. 2. heterogeneous density of the kidneys, especially on the right, with 2.6 cm high-dense focal lesion. as suggested on the prior study, these lesions can be further evaluated by ultrasound. 3. persistent fat stranding along the ascending colon, unchanged compared to the prior study. 4. limited study without intravenous contrast . ectatic appearance of iliac bifurcation. micro: catheter tip-iv source: left sc tlc. wound culture (preliminary): no significant growth. 5:00 pm swab site: arm right wrist wound. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): staphylococcus, coagulase negative. rare growth. and - blood cultures x 2 negative gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): reported by phone to at 12pm. staph aureus coag +. sparse growth. bld cx positive for coag + staph urine cx positive for coag + staph positive mrsa screen brief hospital course: micu course: pt was admitted to the micu after he underwent r ureteral stent placement, but became difficult to wean from the vent post-operatively, and also was found to have mrsa bacteremia. he also grew out mrsa from his urine as well, and also from his r wrist. he was treated with vancomycin, dosed for level<15. plastic surgery was consulted for his r septic wrist, and he went to the or for washout of this joint. he had a tte, which was negative for vegetation. surveillance cultures were negative x 3 days. pt continued to be in arf, despite r ureteral stent placement and l percutaneous nephrostomy. renal service was consulted, and pt was believed to have arf secondary to both recent obstructions as well as atn. his diuretics were held, and his cr began to improve. he then progressed into the post-obstructive diuresis phase, and renal service signed off. his meds were renally dosed during this time. pt was extubated on , and tolerated extubation well. pt was restarted on metoprolol and norvasc, but his acei and lasix continued to be held. he was continued on asa and plavix during his micu stay. he became hypertensive to 150's-160's during the end of his micu course, and his metoprolol was uptitrated. pt was maintained nutritionally by tube feeds while intubated, but began to have thickened liquids after extubation. pt had minor r leg pain prior to leaving the icu, but this pain resolved spontaneously. rle u/s was negative for dvt. of note, pt repeatedly had his ngt curled in his upper esophagus, despite repeated attempts at replacement. this may suggest an abnormality in his upper esophagus, which could be evaluated in the future. . . 1. acute renal failure- the pt has a baseline creatinine of 1.7-1.9. on the last admission to the hospital on , pt had creatinine rise to 2.8. this returned to 2.0 upon discharge to rehab facility. on presentation for this hospitalization , the pt was found to have a creatinine of 7.3 and k of 5.1. on ct scan, pt found to have obstructing r uvj stone and left ureteral stone. he underwent left percutaneous nephrostomy and placement of right stent. he was also found to have mrsa uti and is being treated with vancomycin. despite nephrostomy tube placement and stent, pt continued to have renal failure. this was thought to be due to persistent obstruction and atn. he was never dialyzed. his creatinine has been trending down daily and is currently 3.8 and improving. he will need to follow-up with urology, dr. in weeks. . 2. mrsa pt is currently on day 9 of vancomycin. . 3. mrsa bacteremia- positive blood cultures on . surveillance cultures on and were negative and blood cultures are negative to date. given his septic wrist, he needs to continue vancomycin for a total 4 week course(start date ) with daily vanc troughs checked given his arf. . 4. septic wrist- s/p surgical irrigation and debridement. wound not erythematous or indurated. cultured positive for mrsa. last wound cx on showed coag neg staph. wound catheter tip negative. pt needs to have 4 week course of vancomycin, start date . daily vanc troughs need to be checked with dosing for levels<15. . 5. respiratory failure- pt intubated during surgery and could not be extubated until . tolerated extubation well. maintained on his home o2 dose of 2l continuous. ) . 6. pt usually wears cpap at night, but was not very good about using it at home. after intubation, he had cpap 13 mm hg qhs. . 7. cad s/p mi 3 years ago and cva in with residual r sided weakness. no active issues currently. we continued asa, plavix, metoprolol, statin. . 8. diastolic chf- echo shows ef 55%. pt has resolving left pleural effusion. no jvd, crackles or le edema on exam. cxr showed mod left effusion is unchanged from previous studies today. we did not need to give lasix as patient was in diuresis phase of atn. we continued betablocker and held acei for arf. . 9. pt has history of iron deficiency anemia. stools were guaic negative. crit stable throughout hospitalization, although his hct on discharge was at 24.6. he was given one unit of prbc for goal hct>25, and needs to have a post-transfusion hct drawn tonight. medications on admission: meds on admission: levofloxacin 250mg po daily plavix 75mg daily asa 325mg daily fluoxetine 20mg daily zestril 5mg daily iron sulfate 325mg daily protonix 40mg daily multivitamin lopressor 50mg tid norvasc 5mg daily . meds on transfer: lasix 80mg iv bid propofol gtt metoprolol 50mg tid famotidine 20mg iv daily plavix 75mg daily asa 325mg daily fluoxetine 20mg daily fentanyl gtt heparin sc colace 100mg humalog insulin sliding scale haldol 3-4mg iv prn trazodone 25mg prn hs calcium gluconate prn albuterol prn discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 5. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 6. aluminum hydroxide gel 600 mg/5 ml suspension sig: ten (10) ml po q8h (every 8 hours). 7. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 9. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 10. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 11. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). 13. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 14. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 15. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 16. insulin continue insulin as detailed in the sliding scale sheet. discharge disposition: extended care facility: - discharge diagnosis: primary - mrsa bacteremia, mrsa septic wrist, mrsa uti, arf secondary - cad, chf, iron deficiency anemia, h/o cva, h/o osa discharge condition: stable, afebrile and improving cr discharge instructions: -continue all medications as prescribed -please follow-up with appointments as listed below -continue vancomycin for a total of six weeks (start date ) -daily vancomycin troughs need to be checked, beginning tomorrow -you need to have a post-transfusion hematocrit checked tonight, as you received blood today followup instructions: please follow up with your pcp 2 weeks for follow-up. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous nephrostomy without fragmentation ureteral catheterization retrograde pyelogram transurethral removal of obstruction from ureter and renal pelvis other tenonectomy excision of lesion of tendon sheath of hand diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia acute respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site hydronephrosis calculus of ureter diastolic heart failure, unspecified pyogenic arthritis, forearm 

Answer: The patient is high likely exposed to