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 renal failure; sepsis major surgical or invasive procedure: bronchoscopy picc line history of present illness: 29 yo male quadreplegic with sacral decubitius ulcer admitted to hospital with sepsis and acute renal failure. past medical history: c5 burst fracture sacral decubitus ulcer psh: s/p anterior/posterior spinal fusion ivc filter placement s/p wide excision sacral decubitus ulcer social history: married and has one son etoh family history: non-contributory. physical exam: vs on admission: t 100.0 bp 74 systolic hr 122 o2 sat 94% room air gen: paraplegic male, shaking, ill appearing heent: anicteric sclera, dry, op clear neck: capped trach in place chest: moves air well, no wheezes cor: tachy abd: soft, nt peg in place extr: 1+ non pitting edema both hands, hot & dry. no clubbing neuro: alert and oriented x3 pertinent results: 10:11pm lactate-1.1 09:59pm glucose-119* urea n-50* creat-3.4* sodium-134 potassium-3.5 chloride-107 total co2-12* anion gap-19 09:59pm calcium-7.0* phosphate-4.9* magnesium-1.6 09:59pm wbc-15.4* rbc-3.10* hgb-7.9* hct-25.9* mcv-84 mch-25.6* mchc-30.6* rdw-15.8* 09:59pm plt count-428 09:14pm type-art temp-37.2 o2 flow-3 po2-168* pco2-28* ph-7.25* total co2-13* base xs--13 intubated-not intuba chest (portable ap) 7:39 am chest (portable ap) reason: s/p bronch medical condition: 29 year old man with fevers on abx w/ quadraplegia reason for this examination: s/p bronch chest, single view on history: quadriplegia status post bronchoscopy. findings: there is no significant interval change in the tracheostomy tube or left subclavian line. there is mild cardiomegaly. there is ill definition of the left hemidiaphragm in the retrocardiac regions suggesting volume loss/infiltrate. there is vascular redistribution and pulmonary vasculature ill definition suggesting fluid overload/chf. compared to the film from the prior day, there is no significant interval change. c-spine non-trauma views port 8:45 pm c-spine non-trauma views p reason: eval c spine alignment, soft tissue swelling medical condition: 29 year old man with s/p trauma with repaired c5 burst fx - readmitted for sepsis reason for this examination: eval c spine alignment, soft tissue swelling history: trauma with repaired c5 burst fracture readmitted for sepsis, assess alignment and soft tissue swelling. cervical spine, four views. no previous post-operative cspine xray on pacs record for comparison. comparison is made to cspine ct. there is an anterior plate and screw transfixing the c4 through c5 levels, with intervening fusion plug. no hardware loosening or definite lucency about the hardware is identified. there is marked prevertebral soft tissue swelling. a cerclage wire extends posteriorly from c4 through the c6 spinous processes. the ct scan showed a strut graft in this location, though this is not well demonstrated radiographically (likely due to technique and overlying structures). no listhesis is detected through the level of c7. the lateral masses are symmetric about the dens. of note, the spinous process of c2 on the dens view projects to the left of midline, though the significance of this in this setting is uncertain. on the ap view, some air projects to the right of the cervical spine, but this may also lie within the piriformis recess. the lung apices are obscured by overlying structures. impression: 1. status post fusion procedure at c4/5, with posterior fusion at c4 through c6. posterior strut graft not well demonstrated, likely technical. no listhesis or loosening detected. subtle lucency about the hardware would be difficult to exclude here. 2. marked prevertebral soft tissue swelling, more than on the ct scan of . differential diagnosis includes infection and/or hemorrhage. the small locule of air to the right of the cervical spine most likely represents air within piriform recess; subcutaneous emphysema is considered less likely. 9:12 pm sputum site: endotracheal source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. enterobacter cloacae. moderate growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. staph aureus coag +. sparse growth. of two colonial morphologies. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | staph aureus coag + | | cefepime-------------- 2 s ceftazidime----------- =>64 r ceftriaxone----------- 16 i ciprofloxacin--------- =>4 r erythromycin---------- =>8 r gentamicin------------ 4 s <=0.5 s imipenem-------------- <=1 s levofloxacin---------- =>8 r =>8 r meropenem------------- 1 s oxacillin------------- =>4 r penicillin------------ =>0.5 r piperacillin---------- 64 i rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ <=1 s vancomycin------------ <=1 s 9:22 am catheter tip-iv site: not specified **final report ** wound culture (final ): no significant growth. ct neck w/ & w/o contrast 5:36 pm ct neck w/ & w/o contrast; ct 100cc non ionic contrast reason: hematoma, abscess, edema contrast: optiray medical condition: 29 year old man with s/p c4 injury s/p ant fixation -- ap/lat xray showed soft tissue swelling reason for this examination: hematoma, abscess, edema contraindications for iv contrast: none. indication: 29-year-old male, status post c4 injury and status post anterior fixation of the spine. ap and lateral radiographs of the cervical spine demonstrate a soft tissue swelling. rule out hematoma or abscess. comparison: comparison is made to ct of the cervical spine from . technique: ct of the neck was obtained without and with iv contrast. 100 cc of optiray 350 were administered. nonionic iv contrast was used due to rapid bolus necessary for this study. findings: the patient is status post anterior and posterior fusion of c4/c5. the appearance of the hardware is unchanged from the ct of the cervical spine of is unchanged. the tracheostomy tube is unchanged in position.the skeletal structures are grossly unchanged. there is accumulation of fluid in the prevertebral soft tissues anterior to the vertebral body of c3 as well as c2. however, no definite enhancement is seen around this fluid. this is increased when compared to the prior study. there is a left ij central line with the tip in stable position. there is a tracheostomy tube in good position. examination of the lung apices demonstrated bilateral large pleural effusions and septal thickening which is suggestive of chf/fluid overload. the visualized paranasal sinuses and mastoid air cells are normally aerated. impression: 1. fluid collection the prevertebral space anterior to the c2 and c3 is new when compared to ct of the c-spine from . however, no definite enhancement is seen around this fluid collection to characterize an abscess. nevertheless, early infection in the fluid cannot be excluded. these findings were communicated to dr. at the time of the interpretation. 2. stable appearance of the hardware. 3. findings consistent with chf/fluid overload. 9:40 am blood culture line or site not noted. aerobic bottle (pending): anaerobic bottle (pending): 8:57 am stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. 12:37 am urine **final report ** urine culture (final ): no growth. 12:37 am blood culture aerobic bottle (pending): anaerobic bottle (pending): chest (portable ap) 12:36 pm chest (portable ap) reason: consolidation? medical condition: 29 year old man quadrapelegic with new arf and new spike of fever reason for this examination: consolidation? procedure: ap portable chest. indication: quadriplegic with new acute renal failure, fever. comparison is made to the prior exam of . findings: allowing for differences in technique, the cardiomediastinal borders are unchanged. left internal jugular central venous line has been removed, and right-sided picc line has tip in good position in the distal svc. tracheostomy tube is in good position. there is some improvement to bilateral small pleural effusions and pulmonary edema, with persistent left lower lobe retrocardiac opacity. no pneumothorax. impression: 1. improved appearance of pulmonary edema and small pleural effusions. 2. persistent left lower lobe retrocardiac opacity, probably a collapse but underlying infection cannot entirely be excluded. brief hospital course: patient admitted to the trauma service with acute renal failure and sepsis. his hco3 was corrected; picc line discontinued; tip was cultured which revealed no growth. sputum culture obtained; positive for enterobacter. he underwent bronchoscopy which revealed patent airway. consults from infectious disease, renal and plastic surgery were obtained. he was initially treated with vanco, flagyl and levoflox for the sepsis. id has recommended 6 week course vancomycin and flagyl for the sacral decubitus and a 2 week course meropenem for enterobacter in his sputum. his vancomycin will need to be dosed by levels; should be held for a level greater than 15. recommendations also made by id for imaging of patient's spine to rule out paraspinous abscess. this was obtained on (see pertinent result section of d/c summary). a picc line was placed on for his continued iv antibiotic course. patient with fever spike 103 on hd#9; he was pan cultured; his urine and stool cultures were negative for growth; blood cultures pending at time of this dictation; chest radiograph revealed persistent left lower lobe retrocardiac opacity. he is being continued on his current antibiotic course per id recommendations. his tmax on day of discharge was 99. his renal function will need to be monitored closely after discharge; it is recommended that he have daily chem 10 panel daily for at least a week until his renal function returns to baseline. plastic surgery was consulted for his sacral decubitus, felt wound was healing quite nicely and to continue with current treatment. wound nurse specialist followed patient closely during his hospitalization for his sacral and scrotal wounds. physical and occupational therapy were consulted to continue with his functional progress. speech and swallow were consulted as well, felt to continue with regular diet and oral liquids. nutrition has recommended cycle tube feeds at night and calorie counts. medications on admission: zosyn reglan vanco protonix theophylline discharge medications: 1. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 2. senna 8.6 mg tablet sig: 1-2 tablets po hs (at bedtime). 3. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 5. albuterol sulfate 0.083 % solution sig: one (1) inhalation tid (3 times a day). 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q8h (every 8 hours). 7. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 8. psyllium 1.7 g wafer sig: one (1) wafer po bid (2 times a day). 9. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 10. oxycodone 5 mg/5 ml solution sig: one (1) po q3h (every 3 hours) as needed. 11. theophylline 80 mg/15 ml elixir sig: one (1) po daily (daily). 12. metoclopramide 5 mg/5 ml solution sig: one (1) po tid (3 times a day). 13. oxycodone 5 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed. 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 16. insulin regular human 100 unit/ml solution sig: per sliding scale injection asdir (as directed): see attached insulin sliding scale. 17. meropenem 1 g recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 18. heparin 5,000 units sig: one (1) units subcutaneous three times a day: continue until renal function back to baseline; then switch to lovenox. discharge disposition: extended care facility: - discharge diagnosis: acute renal failure sepsis discharge condition: stable discharge instructions: *continue with your antibiotic course as recommended (see d/c summary) *follow up in trauma and plastic surgery clinics in one month. *daily vancomycin levels.dose vancomycin based on levels less than 15; do not give vancomycin for levels greater than 15. *daily chem 10 panel for at least one week until baseline renal function returns. followup instructions: 1.follow up in trauma clinic in 1 month; call for an appointment. 2.follow up in plastic surgery clinic in 1 month, call for an appointment. procedure: venous catheterization, not elsewhere classified other bronchoscopy removal of other device from thorax diagnoses: pneumonia due to other gram-negative bacteria unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia infection with microorganisms resistant to penicillins sepsis systolic heart failure, unspecified pressure ulcer, lower back accidents occurring in unspecified place gastrostomy status tracheostomy status late effect of spinal cord injury late effects of other accidents carrier or suspected carrier of other specified bacterial diseases quadriplegia, c5-c7, complete 

Answer: The patient is high likely exposed to