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: penicillins / levaquin in d5w attending: chief complaint: respiratory distress major surgical or invasive procedure: tracheostomy change with bronchoscopy and biopsy . picc placement history of present illness: ms. is a 74yo f with history of copd and recent respiratory distress due to copd exacerbation and pneumonia requiring chest tube, vats and eventual trach at earlier this month who presented to the er from ltac with respiratory distress and vent dyssynchrony. . patient was recently hospitalized at from with complicated hospital course. she presented with respiratory distress and given concern for pneumothorax, she underwent needle decompression. patient eventually underwent vats and trach with pleural fluid cultures from the vats revealing vre, proteus, coag-negative staph and . initial sputum cultures revealed pseudomonas. her hospital stay was also complicated by sepsis requiring brief pressor support. her antibiotics were tailored to fluconazole, imipenem and linezolid with plans for additional 10 day course (to end approx ), and she was discharged to ltac on these through a subclavian central line. . at the rehab, she was continued on these antibiotics. patient developed vent discordance and was sent to er for further evaluation. . in the ed, initial vs significant for hypotension with sbp<90. she was started on levophed. patient was also given stress dose steroids, home dose linezolid, 2l of ns and had cxr which showed bilateral pleural effusions and bibasilar atelectasis. ct of her head was remarkable for encephalomalacia and ct torso showed resolving pneumonia, stable aaa and large ventral hernia containing bowel without signs of incarceration. surgery was consulted but felt there was no acute surgical need. patient was unable to have abg drawn and vbg was significant for extreme hypoxemia with gas 7.21/66/29/28. she was admitted to the micu for further treatment. vitals on transfer were 77, 158/81 with levo at 0.06, 94% ac 450x20, 5, 50% fi02. . in the icu, patient is intubated and not following commands or responding to questions. . review of systems: unable to obtain past medical history: - mi - dm - recent respiratory distress s/p trach replacement earlier this month, - copd s/p ruptured diverticulum with prolonged resp failure and trach in rehab for approximately 1 year and removed in - htn - chf diastolic dysfunction - prior cva - depression and anxiety - colostomy to multiple hernia repair(?) - h/o mrsa, c. diff, pseudomonas, vre social history: the patient is a nursing home resident, a former smoker. family history: per records, positive for cad. physical exam: admission physical: vitals: t:99.8rectal bp:154/99 p:64 r:26 o2: 96% general: opens eyes to voice, will not follow commands heent: mucous membranes dry, no lad, perrla neck: jvp not elevated, lungs: harsh upper airway sound from trach with cough leak, clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, no murmurs, rubs, gallops abdomen: soft, non-tender, colectomy site non tender/non erythematous, large right sided pannus with evidence of multiple abdominal surgeries. bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place, macerated area under right sided pannus that is erythematous ext: slightly cool extremities, well perfused, 1+ pedal pulses, no palpable radial or ulnar pulses. bilateral clubbing in feet. no cyanosis or edema . discharge physical: general: opens eyes to voice, follows commands heent: mucous membranes dry, no lad, perrla neck: jvp not elevated, lungs: no audible leak, no rhonchi, no rales, no wheezes cv: regular rate and rhythm, no murmurs, rubs, gallops abdomen: soft, non-tender, colectomy site non tender/non erythematous, large right sided pannus with evidence of multiple abdominal surgeries. bowel sounds present and visible peristalsis, no rebound tenderness or guarding, no organomegaly gu: foley in place, macerated area under right sided pannus that is erythematous ext: slightly cool extremities, well perfused, 1+ pedal pulses, no palpable radial or ulnar pulses. bilateral clubbing in feet. no cyanosis or edema pertinent results: admission labs: 08:00pm blood wbc-12.3* rbc-4.32 hgb-11.1* hct-36.1 mcv-84 mch-25.7* mchc-30.7* rdw-19.7* plt ct-570* 08:00pm blood neuts-85.7* lymphs-9.7* monos-3.4 eos-0.7 baso-0.5 08:00pm blood plt ct-570* 08:00pm blood glucose-133* urean-23* creat-0.5 na-136 k-5.6* cl-104 hco3-24 angap-14 08:00pm blood alt-18 ast-19 ld(ldh)-266* alkphos-153* totbili-0.2 08:00pm blood ctropnt-0.05* 03:22am blood ck-mb-5 ctropnt-0.02* 12:12pm blood ck-mb-4 ctropnt-<0.01 08:00pm blood albumin-3.7 03:22am blood calcium-8.5 phos-3.6 mg-2.0 09:17pm blood type-art tidal v-450 peep-5 fio2-50 po2-29* pco2-66* ph-7.21* caltco2-28 base xs--4 -assist/con intubat-intubated . discharge labs: 04:30am blood wbc-7.4 rbc-3.91* hgb-10.1* hct-31.8* mcv-81* mch-25.8* mchc-31.8 rdw-19.7* plt ct-512* 03:28am blood wbc-10.3 rbc-4.22 hgb-10.7* hct-34.5* mcv-82 mch-25.3* mchc-30.9* rdw-20.3* plt ct-652* 03:03am blood wbc-10.0# rbc-4.03* hgb-10.4* hct-32.5* mcv-81* mch-25.8* mchc-32.0 rdw-19.9* plt ct-585* 03:52pm blood hct-32.5* 04:48am blood wbc-6.2 rbc-3.78* hgb-9.7* hct-30.8* mcv-81* mch-25.6* mchc-31.4 rdw-20.4* plt ct-562* 04:30am blood plt ct-512* 04:30am blood pt-13.4 ptt-22.3 inr(pt)-1.1 03:28am blood plt ct-652* 03:28am blood pt-17.8* ptt-24.3 inr(pt)-1.6* 03:03am blood plt ct-585* 03:03am blood pt-40.0* ptt-31.7 inr(pt)-4.1* 04:48am blood plt ct-562* 04:30am blood glucose-95 urean-8 creat-0.3* na-142 k-4.1 cl-100 hco3-32 angap-14 03:28am blood glucose-108* urean-12 creat-0.3* na-140 k-4.2 cl-97 hco3-32 angap-15 02:36pm blood glucose-100 urean-14 creat-0.4 na-143 k-5.2* cl-102 hco3-31 angap-15 03:03am blood glucose-97 urean-13 creat-0.3* na-142 k-3.3 cl-105 hco3-29 angap-11 . studies: cxr : impression: tubes and lines positioned appropriately. cardiomegaly with bilateral pleural effusions and bibasilar atelectasis. . cxr : impression: limited study demonstrating no definite change. . cxr : findings: the right picc line extends to the mid-to-lower portion of the svc. otherwise little change. . ct torso : impression: 1. resolving bibasilar pneumonia, with trace residual pleural effusions. 2. large left ventral hernia, with simple ascites and mild stranding of the fat and thickening of the omentum within the hernia. consider and element of fat necrosis in the right clinical setting. 3. no evidence of bowel pathology. 4. unchanged suprarenal aortic ectasia and infrarenal aaa. . ip study : read pending . micro: urine culture (final ): no growth. . bcx : pending . 9:08 am sputum site: endotracheal source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. moderate growth. piperacillin/tazobactam sensitivity testing confirmed by . klebsiella pneumoniae. sparse growth. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. piperacillin/tazobactam sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | klebsiella pneumoniae | | ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- 32 r r ceftazidime----------- 32 r =>64 r ceftriaxone----------- r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ 8 i <=1 s meropenem------------- =>16 r <=0.25 s piperacillin/tazo----- =>128 r 16 s tobramycin------------ <=1 s =>16 r trimethoprim/sulfa---- <=1 s bal: 3:30 pm bronchoalveolar lavage right middle lobe. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (preliminary): results pending. brief hospital course: hospital course: ms. is a 74yo f with history of copd and recent respiratory distress requiring vats and trach here with vent dyssynchrony and respiratory distress. pt was continued on broad spectrum abx, and continued course with completed date on . pt had trach changed with ip on , without complications. . active issues: . # respiratory failure: patient has been vent dependent at the rehab facility since trach replacement earlier this month in setting of copd exacerbation and pneumonia. her ct here shows resolving pneumonia, and she has been treated with broad spectrum antibiotics - linezolid, imipenem and fluconazole based on her prior sensitivities from her pleural fluid. once pt admitted, did well on vent without dysynchrony. respiratory distress there attributed bubona trach. she was continued on mdis on the ventilator. ip was consulted regarding change of her trach. the patient had her trach changed on in the or to a long (130mm) flexible trach. the patient afterwards did not have any dyssynchrony. otherwise was not having any respiratory distress. her lung sounds improved and her oxygen saturations were consistent after the trach was replaced. of note, pt had sputum cultures here growing pseudomonas & klebsiella. however, these were thought to be colonization, as pt remained afebrile without leukocytosis or secretions to suggest pneumonia. . # hypotension: most likely continued vap, vs. auto-peep, some sedation. pt required brief levophed in the ed. she was continued on broad spectrum abx with linezolid/meropenem/fluconazole per previous regiment with end date . acs was ruled-out with ce's. auto-peep considered as well, but did not appear to be auto-peeping on vent. c. diff was sent as well, but was negative. bps improved. after the procedure on the patient became hypotensive into the high 70s however quickly resolved with pressures in the 90s after a 500 cc bolus. the hypotension completely resolved 4 hours after the procedure with blood pressures in the 120s. pt has hemodynamically stable at time of discharge. home atenolol 50mg and amlodipine 10mg daily were held during this admission. these should be restarted as needed per her physicians at the ltac. . # diastolic dysfunction: she has known diastolic dysfunction with suggestion of cardiomegaly on cxr. no signs of volume overload on exam but she has received 2 liters of ns in the er. maintained euvolemic volume status with gentle hydration for hypotension as above. appeared euvolemic at discharge. . # h/o hyperglycemia: she had history of glucose intolerance while on steroids at . while here, will have her on fsbs qid with insulin sliding scale while on steroids. her bg were normal on discharge, and insulin was not continued on discharge. this should be followed up further at rehab to assess insulin needs. . inactive issues: . # h/o cva: inr supratherapeutic on admission, and warfarin held. the patient was not restarted on her warfarin given that the reason was for her previous cva and with no history of embolic disease. she was started on an asa 325mg daily. . # large hernia: she has a large ventral hernia containing bowel without signs of incarceration. the patient's pcp was notified and will follow up with general surgery clinic for elective repair. . transitional care: 1. code: full 2. follow-up: - with physicians at ltac 3. medical management: - stop warfarin - completed linezolid/vanc/fluconazole - complete one more day of prednisone 5mg - start aspirin, lansoprazole, chlorhexidine oral care - increase dose of prn ativan - held amlodipine, atenolol - should be restarted as needed at ltac medications on admission: medications: per rehab notes linezolid 600 mg iv bid imipenem 500 mg iv q. 6 hours fluconazole 400 mg po daily albuterol 6puffs q4 mdi albuterol nebs q4 amlodipine 10mg qdaily atenolol 50mg clonazepam 1mg senna daily /mg hydro/simeth 30ml q6 ng prn guaifenesin 300mg q4 ng prn ativan 1mg q4 iv prn morphine 2mg sl q4 prn nitro 0.3mg sl prn prochlorperazine 25mg pr prn clotrimazole 1% cream eucerin flucinolone 0.025% ointment qhs acetaminophen 650mg q6 ng prn miconazole topically and vaginally zinc oxide 40% discharge medications: 1. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours). 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours). 3. acetaminophen 650 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 4. clonazepam 1 mg tablet : one (1) tablet po twice a day. 5. lorazepam 2 mg/ml syringe : two (2) mg injection q4h (every 4 hours) as needed for anxiety. 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. clotrimazole 1 % cream : one (1) topical twice a day. 8. nitroglycerin 0.3 mg tablet, sublingual : one (1) sublingual once as needed for chest pain. 9. prochlorperazine 25 mg suppository : one (1) rectal once a day as needed for nausea. 10. eucerin cream : one (1) topical twice a day. 11. aspirin 325 mg tablet : one (1) tablet po daily (daily). 12. heparin, porcine (pf) 10 unit/ml syringe : two (2) ml intravenous prn (as needed) as needed for line flush. 13. senna 8.6 mg tablet : one (1) tablet po once a day as needed for constipation. 14. prednisone 5 mg tablet : one (1) tablet po daily (daily) for 1 days. 15. maalox advanced 200-200-20 mg/5 ml suspension : thirty (30) ml po every six (6) hours as needed for heartburn. 16. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 17. zinc oxide 40 % ointment : one (1) topical twice a day. 18. miconazole powder : one (1) miscellaneous twice a day. 19. morphine 2 mg/ml syringe : two (2) mg injection every four (4) hours as needed for chest pain, tachypnea. 20. docusate sodium 100 mg tablet : one (1) tablet po twice a day. 21. guaifenesin 200 mg/5 ml liquid : three hundred (300) ml po every four (4) hours as needed for cough. 22. fluocinolone 0.025 % cream : one (1) topical at bedtime. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis trach leak . secondary diagnoses: cad dm copd htn dchf prior cva depression and anxiety colostomy to multiple hernia repair(?) h/o mrsa, c. diff, pseudomona, vre discharge condition: activity status: bedbound. level of consciousness: lethargic but arousable. mental status: confused - always. discharge instructions: you were admitted to for evaluation of respiratory distress. you were found to have an ill fitting tracheostomy. you had this replaced on . your symptoms improved. . medication changes: stop linezolid stop meropenem stop fluconazole continue prednisone 5mg for one more day do not restart coumadin start aspirin 325mg daily start colace 100mg twice daily start lansoprazole 30mg by mouth daily start chlorhexidone oral rinse 15ml twice daily change the dose of lorazepam from 1mg to 2-4mg iv every 4 hrs as needed for anxiety discuss restarting amlodipine and atenolol with your doctors (we held both of these here given low blood pressures) followup instructions: please follow up with the rehab physicians. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours closed [endoscopic] biopsy of bronchus other operations on trachea replacement of tracheostomy tube central venous catheter placement with guidance diagnoses: other iatrogenic hypotension abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use hypovolemia ventilator associated pneumonia chronic diastolic heart failure chronic respiratory failure ventral, unspecified, hernia without mention of obstruction or gangrene mechanical complication of tracheostomy 

Answer: The patient is high likely exposed to