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: history of present illness: this is a 44 year old male with a past medical history significant for multiple medical problems including coronary artery disease, status post four vessel coronary artery bypass graft, atrial fibrillation on coumadin, end stage renal disease on hemodialysis, diabetes mellitus, and left embolic middle cerebral artery cerebrovascular accident, who presents from nursing home with hypotension and bright red blood per rectum. per nursing home report, the patient had a one day history of dark red blood per rectum. he was incontinence of stool and stool amount was unable to further be quantified. his blood pressure dropped to the 80s systolic and he was also noted to be febrile to 102.0. no abdominal pain, nausea, vomiting or hematemesis was noted. the patient had been noted to have a recent inr of 1.6 to 1.8 with a hematocrit of 25, down from his baseline of 29. upon arrival in the emergency department, the patient was tachycardiac with heart rate in the 120s to 140s with a rhythm of atrial fibrillation. his systolic blood pressure was in the 100s. his hematocrit was 27.5 and his inr was 2.0. soon after arrival to the emergency department he had two episodes of dark red blood per rectum with subsequent drops in his blood pressure to a systolic of 70s to 80s. he received 1 liter of normal saline and 2 units of packed red blood cells. he also received 30 ml of proplex to reverse his inr, in addition to 10 mg subcutaneous vitamin k. proplex was chosen given the patient's anuric end stage renal disease and concern for volume overload. the patient also received protonix 40 mg intravenously. following volume resuscitation his blood pressure increased to 110 systolic. he had an nasogastric lavage which showed no evidence of blood or clot. the patient was then admitted to the medicine intensive care unit for further management. past medical history: end stage renal disease on hemodialysis, anuric; diabetes mellitus; diabetic neuropathy; coronary artery disease, status post myocardial infarction; four vessel coronary artery bypass graft in ; congestive heart failure with unknown ejection fraction; peripheral vascular disease; dry gangrene; chronic lower extremity edema, status post left middle cerebral artery, stroke with residual right hemiparesis and wernicke's syndrome; bilateral carotid stenosis, less than 40%, history of methicillin-resistant staphylococcus aureus infection in sacrum on linezolid since ; hyperparathyroidism; calciphylaxis; chronic anemia; decubitus ulcers; status post pneumonia. social history: nursing home resident, sister guardian, no current tobacco or alcohol use. family history: mom with cerebrovascular accident, dad with myocardial infarction at age 50. medications on admission: lopressor 100 t.i.d., aspirin 325 q. day, coumadin 2.5 q. day, digoxin .125 q. 72 hours, lipitor 40 mg q.h.s., imdur 60 mg q. day, risperdal .75 q.h.s., 70/30 insulin, 32 units in the morning, 30 units in the evening, zoloft 25 q.h.s., colace and senokot q. day, verapamil 40 mg q.i.d., renagel 4000 mg t.i.d., colchicine .6 q. day, linezolid 600 b.i.d., started on . physical examination: on admission temperature was 101.5, heart rate 118, blood pressure 101/65, respiratory rate 16, oxygen saturation 100% on 2 liters of oxygen. general: somnolent, confused, garbled speech in no acute distress. head, eyes, ears, nose and throat: pupils equal, round and reactive to light and accommodation. extraocular movements intact, sclera anicteric. dry mucous membranes. neck: soft and supple, no jugulovenous distension. cardiovascular: tachycardiac, irregular rate and rhythm, no murmurs. pulmonary: clear to auscultation bilaterally. abdomen, obese, soft, nontender, positive bowel sounds auscultated. extremities: bilateral lower extremity and feet bandages. multiple large eschar to calciphylactic lesions on bilateral thighs, groins, buttocks and sacral decubitus ulcer. no grossly purulent discharge or erythema noted from leg lesion. neurological: confused with waxing and mental status. positive confabulation. follows simple commands. moves bilateral lower extremities and left upper extremities. laboratory data: on admission white count 11.8, hematocrit 27.5, platelets 391, pt 17.3, ptt 28.3 with an inr of 2.0. sodium 145, potassium 4.9, chloride 105, bicarbonate 31, bun 34, creatinine 3.9, glucose 72. lactate of 1.4. liver function tests were within normal limits. electrocardiogram, atrial fibrillation, read of 136. chest x-ray, no effusion or infiltrate. hospital course: 1. gastrointestinal bleed - the patient presented from the nursing home with bright red blood per rectum. he initially had an nasogastric lavage which was negative. he was evaluated by the gastroenterology service. he underwent endoscopy which showed no acute lesions. he then underwent colonoscopy which did show residual old blood, however, no clear source of bleeding was able to be localized. the patient was placed on a high dose proton pump inhibitor. serial hematocrits were followed and he was transfused as needed. in addition, he was taken off of his anticoagulation. the patient's presenting gastrointestinal bleed did occur in the context of an elevated inr on coumadin therapy. initially his inr was reversed with proplex. he also received vitamin k with normalization of his inr off anticoagulation therapy. he did have no further episodes of bleeding. initially plans were made for a repeat colonoscopy to further look for a bleeding source. however, following discussion with the family, it was decided that given the patient's multiple medical issues, further colonoscopy or gastrointestinal studies would not be pursued at this time. 2. hypertension - the patient presented with acute hypotension, presumably due to hypovolemia due to his gastrointestinal bleed. he was fluid-resuscitated with blood and intravenous fluids and his blood pressure responded accordingly. he continued to receive blood and fluids as needed throughout the hospital stay. 3. gram negative rod bacteremia - the patient was initially febrile at presentation and was cultured with no organism isolated. he then was afebrile until when he again spiked a fever. subsequent blood culture did grow out gram negative rods. given the patient's extensive calciphylactic lesions on his lower extremity and potential for contamination with stool given the fecal incontinence he was thought to have likely seated his blood with bowel organisms via his lower extremity lesions. he was started on zosyn with resolution of his fever on antibiotics. cultures continued to be followed with plans to further tailor his antibiotic therapy once an organism is isolated. he received intravenous fluids as needed to support his blood pressure. he also received blood as needed for sepsis protocol. cortisol level was sent which did show appropriate renal response. plan to continue to follow up cultures. 4. methicillin-resistant staphylococcus aureus - patient admitted with known methicillin-resistant staphylococcus aureus in his sacral decubitus ulcer. he had been on linezolid. he was switched to vancomycin at admission and was continued on this. no further methicillin-resistant staphylococcus aureus was isolated from blood cultures or wound cultures. his vancomycin was renally dosed, given his renal failure. 5. atrial fibrillation - the patient was admitted with a history of atrial fibrillation for which he had been on lopressor for rate control and coumadin anticoagulation. given his gastrointestinal bleed as detailed above, he was taken off of the coumadin. initially his lopressor was held given his hypotension, however, as this resolved, he was slowly started back on his lopressor and his dose was titrated up as tolerated. 6. calciphylaxis - the patient was with extensive calciphylactic lesions for which he had previously had a prolonged hospitalization. he was followed by renal for this and received daily hemodialysis for his calciphylaxis. he was also treated with high dose of renagel. plastics was consulted to evaluate his lesions and he did undergo debridement. however, the patient suffered significant pain and discomfort with debridement and per discussion with the family decided that no further debridement would be undertaken in order to manage the patient's comfort. 7. coronary artery disease - the patient's aspirin was held given his gastrointestinal bleed. initially his beta blocker was held given his hypotension. this was slowly added back on with plans to titrate up. he was also maintained on his statin per his outpatient regimen. 8. diabetes mellitus - the patient was admitted with diabetes with multiple complications. he was maintained on nph insulin with sliding scale supplementation, per his outpatient regimen. given his decreased p.o. intake, his insulin dosing was subsequently adjusted. he was actually taken off of his nph insulin and was covered with his sliding scale insulin. should his blood sugars again trend up and his dietary needs change, he will be restarted on his nph. blood sugars were followed q.i.d. 9. end stage renal disease on hemodialysis - the patient was followed by the renal team throughout his stay and was dialyzed as per schedule. his original schedule was for q. monday, wednesday and friday but in the setting of calciphylaxis he did receive pulmonary more frequent dialysis sessions with less fluid taken off. 10. fluids, electrolytes and nutrition - the patient is initially npo for his gastrointestinal bleed. as this stabilized he was advanced on clears and then to a regular diabetic diet as tolerated. 11. heme - the patient's hematocrit and inr followed as detailed above. he received multiple blood products to support his counts as needed. 12. code status - given the patient's multiple medical problems, it was decided he would want to be do-not-resuscitate, do-not-intubate with no pressors. he also will not receive debridement of his wound or further gastrointestinal workup in an effort to maximize comfort. the remainder of the hospital course, diagnoses and discharge medications will be dictated by the subsequent intern. should he have a cardiac or respiratory code, it was also decided that he would not wish for pressors. given goals of maximizing patient comfort, he will not have any further debridement of his extremity wounds, nor will he undergo repeat colonoscopy for bleed. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine hemodialysis excisional debridement of wound, infection, or burn colonoscopy transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics diagnoses: congestive heart failure, unspecified atrial fibrillation aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia long-term (current) use of anticoagulants hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to