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: oxycodone attending: chief complaint: change in mental status, uti, septic shoulder major surgical or invasive procedure: procedure: attempted closed reduction, left glenohumeral joint. irrigation and debridement, open, of left glenohumeral joint open anterior reconstruction, left shoulder (modified bankart procedure). history of present illness: 86 y.o. female. admission in mid for septic left shoulder(mrsa), discharged to rehab on vanco via picc and now presents (after an initial work-up at ) with change in mental status, dislocated left shoulder, and decreased urinary output. she was transferred at the request of her daughter given that she receives most of her care at . she was a/ox3 at home. she was found to have +uti, 6 of 6 bottles of gram negative rods, negative head ct. vancomycin was continued dosed by level and levofloxacin given empirically. her shoulder pain responded well to low dose morphine. on went to surgery for shoulder debridement, irrigation and placement. on transferred to micu overnight for hypotension, gi bleed (had guaiac + black stool), refused c-scope, now guaiac negative. gram negative rods determined to be enterobacter, meropenem started. pt's mental status markely improved throughout the course of the abx and post-surgical intervention. she will needed extended abx tx as an outpt and significant pt follow-up for her shoulder. to be placed in rehab. past medical history: cad (mibi reversible defect ant/apical not intervened) chf (ef 55% with diastolic failure from htn) afib (now in sinus on amio) cri (blc 1.7) venous stasis, dvt (s/p ivc filter) lgib, diverticulosis left hip replacement right tkr pacer social history: lives in . family very involved in her care. no etoh, tob, drugs. enjoys gospel music and church. family history: unsure of parent's cause of death physical exam: t97.3, bp106/72, p80, r18, o2sat100%ra heent: left eye cataract, eomi, right eye perrl, poor dentition, no op erythema, no lad chest: ctab anteriorly heart: rrr, nl s1/s2 abd: obese, bs+, nt, nd ext: 1+ pitting edema b/l, left anterior shoulder dislocation, warm, pulses 2+ (radial,dp) neuro: axox1, 5+ strength throughout(except left upper extremity could not be examined secondary to pain), reflexes 2+ throughout (except left upper extremity could not be examined secondary to pain). difficult to assess pt's sensation given ms change. pertinent results: 12:24am lactate-1.9 11:11am sed rate-125* 11:11am pt-13.9* ptt-29.9 inr(pt)-1.3 11:11am plt count-373 11:11am wbc-9.0 rbc-3.10* hgb-9.1* hct-29.3* mcv-95 mch-29.2 mchc-30.9* rdw-14.2 11:11am vanco-24.0* 11:11am crp-24.01* 11:11am albumin-2.3* calcium-8.7 phosphate-4.0 magnesium-1.8 11:11am glucose-79 urea n-56* creat-2.2*# sodium-135 potassium-4.0 chloride-99 total co2-21* anion gap-19 11:55am urine rbc->1000* wbc-0 bacteria-none yeast-many epi-0 11:55am urine blood-lge nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-sm 11:55am urine color-brown appear-cloudy sp -1.020 blood cx: enterobacter cloacae 1 of 1 bottles blood cx: enterobacter cloacae 2 of 2 bottles blood cx: no growth blood cx: pending sensitivities set1 set2 set3 cefepime-------------- 16 i <=1 s 2 s ceftazidime----------- 32 r =>2 s 4 s ceftriaxone----------- =>64 r =>64 r =>64 r ciprofloxacin--------- 2 i =>4 r gentamicin------------ <=1 s 4 s =>16 r levofloxacin---------- 1 s 4 i 4 i meropenem------------- 0.5 s <=0.25 s <=0.25 s piperacillin---------- =>128 r =>128 r =>128 r tobramycin------------ 8 i 8 i =>16 r trimethoprim/sulfa---- =>16 r =>16 r =>16 r shoulder joint cx: enterobacter cloacae sensitivities: mic expressed in mcg/ml cefepime-------------- <=1 s ceftazidime----------- 4 s ceftriaxone----------- 32 i ciprofloxacin--------- 2 i gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin---------- =>128 r tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r urine culture (final ): yeast. 10,000-100,000 organisms/ml urine culture (final ): yeast. 10,000-100,000 organisms/ml lt. shoulder mrsa pt was on vanco,merepenim,& kefzol. shoulder swab: gram stain (final ): 2+ ( per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (preliminary): no growth brief hospital course: this is an 86 year-old female recently admitted in mid with septic l shoulder (coag + staph) on vanco via picc, s/p left shoulder washout and tee negative for endocarditis. admitted from after found to have uti and altered ms and transferred here at request of daughter and found to have l shoulder dislocation, reduced 1 at and 2 at ed. at nursing facility patient also found to have altered mental status, decreased urine output, and azotemia. mental status change/id: subsequently, patient found to have enterobacter bacteremia with sensitivity only to meropenam. patient's mental status improved significantly with iv antibiotics with some baseline waxing and . recently mrs. , in addition to her medical issues, suffered the loss of her husband. this grieving and possible depression has lead to some withdrawal. would recommend appetitite stimulants, possible anti-depressants at discretion of physicians at to help with mentation. **most importantly, patient will need continued vanco for mrsa until and meropenem enterobacter cloace until . she has been blood culture surveillance negative since initial cultures and has been afebrile with declining wbc. shoulder dislocation: s/p debridement, open anterior reconstruction, and aspiration of her left shoulder joint now in sling. patient's course has been very complicated, with multiple dislocations, now a chronic dislocation and severe pain. ortho at feels that continued surgical options are limited and recommend sling, with good pain control. patient will need further evaluation, most likely at for further options of management. chf with ef 55% with diastolic dysfunction: patient with respiratory distress during this admission. gentle diuresis of lasix 20 mg po every other day has kept her in good fluid balance. currently her blood pressure has dropped to 80's/40/s with good response to fluid but she has maintained hemodynamic stability after her gi bleed (see below) gi bleed with anemia: patient hemodynamcially stable, with stable crits after a brief lower gi bleed, likely secondary to diverticulosis -guaiac +, black stool, but patient did not want colonoscopy. her goal crit is >30. atrial fibrillation: has been in sinus on amio. not on coumadin secondary to gi bleed. cad: h/o abnormal pmibi in . had intermittent chest pain on with ecg demonstrating t-wave inversions in anterior leads. per cards fellow, patient was not ruled out, asa held due to bleed. beta-blocker maintained, with occasional holding for low bp's. will not rule out. holding asa secondary to bleed. now stable, without chest pain or associated symptoms. pain: pain is now well controlled on current regimen. would recommend continuation. nutrition: patient with decreased po intake over past 2 days prior to discharge. likely secondary to grieving/depression with loss of her husband. would consider appetite stimulants, anti-depressants at discretion of treating physician at /dr. . code status: dnr/dni disposition: patient to go to with close f/u with dr. . she will likely need further eval by orthopoedics, possibly at for further care of shoulder dislocation. medications on admission: nitroglycerin sl 0.3 mg sl asdir one tab q5min prn for chest pain nte 3 tabs pantoprazole 40 mg po q24h nystatin oral suspension 5 ml po qid sarna lotion 1 appl tp tid lumigan 1 drop od qhs amiodarone hcl 200 mg po qd metoprolol 25 mg po bid simvastatin 40 mg po qd polysaccharide iron complex 150 mg po qd docusate sodium 100 mg po bid senna 1 tab po bid:prn bisacodyl 10 mg po qd:prn aspirin 325 mg po qd discharge medications: vancomycin hcl 1000 mg iv q48h meropenem 1000 mg iv q12h pantoprazole 40 mg iv q24h heparin 5000 unit sc q12h nitroglycerin sl 0.3 mg sl asdir one tab q5min prn for chest pain nte 3 tabs morphine sulfate 0.5-2 mg iv q3-4h:prn nystatin oral suspension 5 ml po qid sarna lotion 1 appl tp tid lumigan 1 drop od qhs amiodarone hcl 200 mg po qd 1. vancomycin hcl 1000 mg iv q48h 2. amiodarone hcl 200 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 3. bimatoprost 0.03 % drops sig: one (1) drop ophthalmic qhs (). disp:*qs 1 month* refills:*2* 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. disp:*qs 1 month* refills:*0* 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. disp:*qs 1 month* refills:*0* 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual asdir (as directed). disp:*5 tablet, sublingual(s)* refills:*2* 7. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection q12h (every 12 hours). disp:*60 injection* refills:*2* 8. morphine sulfate 0.5-2 mg iv q3-4h:prn pain 9. pantoprazole 40 mg iv q24h 10. meropenem 1000 mg iv q12h 11. lasix 20 mg tablet sig: one (1) tablet po qod. disp:*15 tablet(s)* refills:*2* 12. morphine sulfate 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 1. vancomycin hcl 1000 mg iv q48h 2. amiodarone hcl 200 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 3. bimatoprost 0.03 % drops sig: one (1) drop ophthalmic qhs (). disp:*qs 1 month* refills:*2* 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. disp:*qs 1 month* refills:*0* 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. disp:*qs 1 month* refills:*0* 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual asdir (as directed). disp:*5 tablet, sublingual(s)* refills:*2* 7. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection q12h (every 12 hours). disp:*60 injection* refills:*2* 8. morphine sulfate 0.5-2 mg iv q3-4h:prn pain 9. pantoprazole 40 mg iv q24h 10. meropenem 1000 mg iv q12h 11. lasix 20 mg tablet sig: one (1) tablet po qod. disp:*15 tablet(s)* refills:*2* 12. morphine sulfate 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 1. vancomycin hcl 1000 mg iv q48h 2. amiodarone hcl 200 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 3. bimatoprost 0.03 % drops sig: one (1) drop ophthalmic qhs (). disp:*qs 1 month* refills:*2* 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. disp:*qs 1 month* refills:*0* 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. disp:*qs 1 month* refills:*0* 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual asdir (as directed). disp:*5 tablet, sublingual(s)* refills:*2* 7. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection q12h (every 12 hours). disp:*60 injection* refills:*2* 8. morphine sulfate 0.5-2 mg iv q3-4h:prn pain 9. pantoprazole 40 mg iv q24h 10. meropenem 1000 mg iv q12h 11. lasix 20 mg tablet sig: one (1) tablet po qod. disp:*15 tablet(s)* refills:*2* 12. morphine sulfate 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* discharge disposition: extended care facility: & rehab center - discharge diagnosis: mental status change sepsis (shoulder + uti) shoulder dislocation atrial fibrillation coronary aretery disease, hyperension discharge condition: stable discharge instructions: if pt experiences significant mental status changes, cp, sob, palpitations, gi bleeding she should seek immediate medical attention. followup instructions: --on meropenem for enterobacter cloacae (6/6 bottles) continue until --on vancomycin for mrsa continue until --check cbc w/ diff, creatinine, vanco trough, ast, alt once a week as outpt and fax results dr. () --call/page dr. before discharge so he can make f/u appt in his clinic, he will follow the sensitivities to gram neg rods. procedure: venous catheterization, not elsewhere classified arthrocentesis transfusion of packed cells closed reduction of dislocation of shoulder other local excision or destruction of lesion of joint, hand and finger repair of recurrent dislocation of shoulder diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation candidiasis of mouth hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other septicemia due to gram-negative organisms diastolic heart failure, unspecified diverticulosis of colon with hemorrhage pyogenic arthritis, shoulder region 

Answer: The patient is high likely exposed to