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: sepsis and gangrene of the right foot major surgical or invasive procedure: - procedure: right below-the-knee guillotine amputation. - procedure: closure of right below-knee amputation. - procedure: 1. bronchoscopy and tracheostomy 2. upper endoscopy and placement of percutaneous endoscopic gastrostomy. history of present illness: 63 y/o m c/ r foot wound on vac at home, s/p multiple debridements, presented to ed septic with r foot gangrene past medical history: 1. esrd on hd dm and htn (since on tu-th-sat) 2. dm - retinopathy - neuropathy in calves and feet 3. htn 4. hyperlipidemia 5. chronic cough 6. s/p cataract surgery 7. osa 8. history of tobacco abuse social history: lives with wife. two-pack-year for 20 years. quit 20 years ago. alcohol 3 times per week. he was a heavy drinker in the past of unclear significance. family history: diabetes mellitus type ii pad increase cholesterol esrd on hd (m/w/f), transplant list, htn physical exam: n/a pt expired pertinent results: 02:29am blood wbc-11.1* rbc-2.58* hgb-7.7* hct-23.6* mcv-92 mch-29.7 mchc-32.5 rdw-20.5* plt ct-234 09:30am blood pt-17.6* ptt-43.7* inr(pt)-1.6* 02:29am blood glucose-162* urean-57* creat-7.3*# na-140 k-4.1 cl-102 hco3-26 angap-16 02:44am blood alt-389* ast-144* alkphos-219* amylase-24 blood culture aerobic bottle (final ): no growth. anaerobic bottle (final ): reported by phone to 8am. citrobacter freundii complex. trimethoprim/sulfa sensitivity testing available on request. 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. final sensitivities. enterococcus faecalis. final sensitivities. high level gentamicin screen: resistant to 500 mcg/ml of gentamicin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. high level streptomycin screen: susceptible to 1000mcg/ml of streptomycin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details.. sensitivities: mic expressed in mcg/ml _________________________________________________________ citrobacter freundii complex | enterococcus faecalis | | ampicillin------------ <=2 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ 4 s imipenem-------------- <=1 s linezolid------------- 2 s meropenem-------------<=0.25 s penicillin------------ 8 s piperacillin---------- =>128 r tobramycin------------ 8 i vancomycin------------ =>32 r brief hospital course: - pt admitted throught the er / sepsis / ischemic foot sent to the or for immediate amputaton in holding area of or - he 'coded' in pre-op, becoming asystolic, with an initially failed intubation, entering the esophagus. forty-five minutes elapsed before his cardiorespiratory state was stable, with an unclear duration and degree of cerebral hypoperfusion. he received multiple shocks, epinephrines. transfered to the cvicu in critical condition cvicu pea, then asystole, then pea again. pt started on pressors / resp support / pan cx'ed pt critical / bedside procedure: right below-the-knee guillotine amputation. pt recieved line / cxr broad spectrum antibiotics started stat ecg echo cta chest ct abdomen ct pelvis ct head pt experiences shock liver / transplant consulted - pt never recovered had abd us impression: 1. patent portal vein. 2. periportal and gallbladder wall edema, in addition to ascites and small pleural effusions is consistent with third spacing. hypoechoic appearance of the liver is compatible with hepatic congestion or hepatitis. 3. no evidence of intra- or extra-hepatic biliary ductal dilatation. - during sedative medication pt was weaned he has been unresponsive whilst awake, and periods of sleep have been associated with hypotension and apnea. he did not show apparent spontaneous movement. require insulin drip for increase bs - followed pt / guidelines adhered to nuerolgy consulted mr is likely in a persistant vegetative state with cardiorespiratory support. despite the withdrawal of sedatives, he has not regained a meaningful level of consciousness, instead only exhibiting some, but not other, brainstem reflexes, and neither myotatic nor noxious spinal reflexes. the disturbance of consciousness is suggestive of disruption of the rostral brainstem, hypothalamus, basal forebrain, or diffuse cortical injury. mri will help resolve the cause of his coma, and now coma vigil, but it is unlikely that improvement in his level of consciousness will occur. importantly, there is no other obvious sytemic cause to his impaired consciousness, such as electrolyte or metabolic disturbance, and his blood gases and temperature are within the normal range. one final test that may be considered, to exclude renal encephalopathy, is blood ammonia level. since patient has been ongoing hemodialysis, we will repeat neurological examination to confirm his neurological state. the absence of spinal reflexes are either due to peripheral neuropathy or damage to spinal motorneurons. in the context of asystole, spinal infarction is possible. mr has absent oculocervical reflexes, which are more likely to be due to brainstem damage, than to symetric bilateral damage to either the eighth, or both the third and sixth cranial nerves. however, rest of the brainstem examination is relatively intact including the presence of blink to threat, the corneal reflex and gag reflex. overall, mr is likely to be in a persistant vegetative state, with quite limited meaningful neurological recovery if not none. in view of the hiatus since the asystolic event, may only recover marginally, and remain presistantly vegetative. nonetheless, repeat serial examination will be performed to document any trends in his neurological function. similarly, an electroencephalogram may provide some further information about the degree of forebrain activity and ruling out subclinical seizures - thoracics consult / followed / pt dnr following shock liver pt brought down for closure of right below-knee amputation, 1. bronchoscopy and tracheostomy 2. upper endoscopy and placement of percutaneous endoscopic gastrostomy. eeg this is an abnormal portable eeg due to the slow and disorganized background rhythm. this is suggestive of a moderate encephalopathy which may be seen with medication effect, toxic metabolic abnormalities, or infections. there were no regions of focal slowing and no epileptiform discharges noted. picc placed for access - pressure support / intubated / tf / dnr broad spectrum antibiotics continued / cx's followed echo multiple family meeting to determine pt status / family unwilling to make cmo. pt still requires full sedation / tf / pressure support / fluid resusitation family cmo morphine drip pt expires shortly after medications on admission: : nph 23/15, albuterol, norvasc 5', asa 81', bumex 1', carvedilol 12.5'', flumisonide (home), fosinopril 40', metoprolol 50', metolazone 5 qod discharge medications: n/a pt expired discharge disposition: extended care facility: northeast - discharge diagnosis: n/a pt expired discharge condition: n/a pt expired discharge instructions: n/a pt expired followup instructions: n/a pt expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube hemodialysis other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy other amputation below knee repair of entropion or ectropion with wedge resection revision of amputation stump diagnoses: end stage renal disease anemia, unspecified unspecified septicemia severe sepsis cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease cardiac arrest anoxic brain damage septic shock gangrene acute osteomyelitis, ankle and foot diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to