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: clindamycin attending: chief complaint: necrotizing fasciitis major surgical or invasive procedure: - radical debridement of soft tissues of r chest wall, abdominal wall, flank, groin; step incisions in abdominal wall fascia & musculature with drainage of peritoneal abscess - repeat debridement of necrotic soft tissues of r chest, abdominal wall, b/l groins, additional step incisions in abdominal wall fascia & musculature with drainage of peritoneal abscess - tracheostomy with 8-0 cuffec portex tube, irrigation & debridement of wounds with further drainage of periappendiceal abscess, placement of 26fr mushroom-tipped catheter into appendiceal stump within cecum - ivc filter placement - vac dressing change under general anesthesia - vac dressing change under general anesthesia - preparation of wound bed with debridement & excision of scar, meshed skin graft (16/1000" meshed at 1.5, total surface area 40x55 cm) - removal of bolster, skin graft, replacement of wound dressing with duoderm gel & xeroform gauze history of present illness: 32m with long history of steroid abuse leading to multiple joint replacements, including both hips and both knees. he was an inpatient at for 6 weeks prior to admission for septic left knee joint (cultured for mrsa & ). he underwent i&d of the joint and developed mrsa and citrobacter sepsis. id at nebh stsarted linezolid, diflucan, and cipro. he developed fevers, chills, and significant right-sided abdominal and flank pain with extensive erythema and induration of the soft tissues. a ct scan revealed multiple peritoneal, retroperitoneal, intrahepatic, pseudopancreatic, and pelvic cysts. his wbc rose to 40. he was transferred to for ir aspiration cytology of cysts and further management. past medical history: pmh: -seronegative arthritis, possibly ankylosing spondylitis, of hips, knees, wrist, on steroids/immunosuppressants since (methotrexate, sulfasalazine, enbrel, humira, remicade, prednisone) -anemia of chronic disease -mrsa infection -pud -anabolic steroid abuse (16 months in early 20s) . psh: -l tkr c/b wound dehiscence & septic arthritis in -r thr -l thr -r thr -l tibial osteotomy -l4-l5 laminectomy (s/p mva with traumatic disc herniation) social history: disabled, lives with mother in , ma. was a semiprofessional body builder in early 20s with h/o anabolic steroid abuse x 16 months. tobacco 1 pack/day x 10 years. denies alcohol use. family history: noncontributory physical exam: on admission: vs: t: 102.4 hr: 120-130 bp: 110s/50s rr: 25 sat: 96% on 4l cvp ~18 gen: slightly drowsy, answering all questions appropriately, slightly diaphoretic, somewhat uncomfortable appearing heent: ncat, perrl, sclera anicteric, op with bari-cat covering mucosa (pt prepping for ct), dentition appears to be in good repair neck: obese, jvd unable to be assessed cv: tachy, s1/s2, no m/r/g pulm: cta b/l abd: obese, distended, striae present, skin is erythematous and weeping w/ serous fluid, particularly over rlq, tender in rlq & llq, bs+ ext: anasarca, 3+ le pitting edema dp pulses are 2+ bilaterally neuro: a&o x 3, cn ii-xii grossly intact, moves all extremities, sensation intact to light touch skin: plethoric/erythema over face. erythema over abd/chest/lower extremities, particularly anteriorly. no desquamation. gu: testicular edema . on discharge: vs: t: 97.7 hr: 91 bp 118/78 rr: 18 sat: 96%ra gen: nad, a&o x3 cvs: rrr, nl s1/s2, no m/r/g pulm: cta b/l abd: obese, appropriately tender, skin graft taking well over right abdomen & chest, cecostomy pink/viable in appliance with +stool ext: b/l skin graft donor sites dry, tender, b/l le 2+ edema pertinent results: on admission: 11:02pm glucose-128* urea n-20 creat-0.9 sodium-136 potassium-3.7 chloride-94* total co2-30 anion gap-16 11:02pm albumin-2.6* calcium-8.7 phosphate-3.3 magnesium-1.8 11:02pm alt(sgpt)-27 ast(sgot)-57* ld(ldh)-301* alk phos-151* amylase-6 tot bili-0.4 11:02pm lipase-12 11:02pm wbc-25.3* rbc-3.10* hgb-9.0* hct-27.8* mcv-90 mch-29.0 mchc-32.3 rdw-17.1* 11:02pm plt smr-normal plt count-230 11:02pm neuts-91* bands-3 lymphs-4* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-1* 11:02pm hypochrom-1+ anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal teardrop-occasional 11:02pm pt-14.5* ptt-35.0 inr(pt)-1.3* 11:02pm sed rate-82* . ct abdomen w/contrast 12:45 am impression: 1. multiple intra-abdominal fluid collections which appear cystic in quality. though the majority of them are remote from the pancreas, pancreatic pseudocysts remain in the differential. the fluid collection in the right lower quadrant is infiltrating the fascia and associated with significant subcutaneous edema and stranding, concerning for necrotizing infection of the fascia in this locale. 2. dilated loops of bowel likely due to an ileus. no wall thickening or pneumatosis. 3. right lower lobe consolidation versus atelectasis. additional focus of airspace opacity in the right upper lobe is concerning for infection. . scrotal us 5:03 pm impression: relatively symmetric vascular flow within the testes, bilaterally. marked, diffuse scrotal skin thickening, with no focal collection or gas identified. . ct torso w/contrast 10:30 am impression: 1. small bilateral pleural effusions with associated atelectasis. 2. no significant change in intraabdominal fluid collections. 3. extensive debridement of right anterior abdominal wall with associated packing material. . ct guidance drainage 10:23 am impression: successful ct-guided placement of pigtail catheters in two largest fluid collections in upper abdomen. samples from both fluid collections sent for culture and stain. . ct guidance drainage 10:27 am impression: 1. patient status post upsizing of the catheter in a midline subphrenic collection and placement of two additional catheters in left lower quadrant and a perisplenic collections, without complication. 2. significant interval decrease in the size of the right subphrenic fluid collection. 3. persistent peripancreatic fat stranding, which may be secondary to pancreatitis. correlation with laboratory values is recommended. 4. a focal hepatic hypodensity cannot be definitively characterized on this study. however, given its rapid appearance and somewhat tubular configuration, portal vein thrombus should be considered. an abscess would be less likely. 5. suggestion of expansion and luminal hypodensity in the right common femoral vein. a deep vein thrombus cannot be excluded and ultrasound correlation is recommended. 6. suspicion for oral contrast tracking along the right lateral abdominal subcutaneous tissues. although no definite tract is visualized, an enterocutaneous fistula cannot be excluded. . bilat lower ext veins p 6:01 pm impression: nonocclusive thrombus within the right popliteal vein extending up to the mid right sfv. . ct abscess cath change 11:37 am impression: 1. patient status post upsizing of a catheter in a subphrenic fluid collection, with removal of 400 cc of fluid. 2. interval resolution of the perisplenic and left lower quadrant fluid collection, with stable near-complete resolution of the perihepatic collection. 3. tracking of oral contrast along the cecostomy tube tract, some of which may be intraperitoneal in location. 4. new presumed packing material within the right lower quadrant adjacent to the patient's large subcutaneous defect. . ct abdomen w/o contrast 12:44 pm impression: compared to prior ct from , the sizable left subphrenic fluid collection has decreased in size and now measures 9.5 x 5.8 cm, previously 10.9 x 9.6 cm. no significant colleciton is identifed in the region of the three additional drains. no new fluid collection. findings discussed with dr. . . on discharge: 05:59 pm glucose-169* urea n-5 creat-0.4 sodium-140 potassium-3.9 chloride-100* total co2-36 anion gap-8 05:59 pm calcium-7.8 phosphate-4.9 magnesium-1.8 05:59 pm wbc-11.9* rbc-2.92* hgb-8.3* hct-26.0* mcv-89 mch-28.4 mchc-31.9 rdw-15.1* 05:59 pm plt count-371 4:27 am pt-20.1* inr(pt)-1.9* brief hospital course: patient was transferred to from on . he was admitted to the micu with r abdominal & flank pain with extensive erythema and induration of the soft tissues. id was consulted. he was started on linezolid, meropenem, and caspofungin. a prednisone taper was planned. he was continued on lovenox. overnight, he deteriorated. surgery was consulted for necrotizing fasciitis. he was taken emergently to the or for radical debridement with step incisions in the abdominal wall fascia & musculature on . he remained intubated, sedated, and went to the sicu postoperatively, where he required levophed to maintain his bp. on , he returned to the or for repeat debridement and additional step incisions. a vac was placed and required changes q3days. overnight, he was stable without pressor requirement, but remained intubated and sedated. his cultures grew citrobacter, which was appropriately covered by meropenem. he remained on linezolid and caspo empirically for c.albicans and gnc in l knee cultures from nebh. tube feeds were started on . urology was consulted for scrotal edema and retracted penis. ultrasound demonstrated symmetric blood flow and was negative for evidence of necrotizing fasciitis. on ortho was consulted for h/o septic joint. a knee aspirate was performed; the culture was negative. chronic pain was consulted and recommended methadone, increased pregabalin and ativan gtt to wean down fentanyl gtt. a ct torso performed on did not demonstrate significant change in the intraabdominal fluid collections. on , he went to the or for tracheostomy, further i&d with drainage of periappendiceal abscess, and placement of cecostomy tube. a swab grew vre, non albicans , and s. aureus. a ct torso performed on failed to demonstrate oral contrast extravasation (i.e. enterocutaneous fistula). two pigtail drains were placed into his intraabdominal fluid collections with ct-guidance. the fluid drained grew citrobacter. ativan gtt was weaned off. propofol was weaned off the following day. he remained on fentanyl gtt. trach collar trials were tried daily. on , he underwent ct-guided placement of 2 additional drains as well as upsizing of one previously placed drain. fluid culture grew citrobacter, again appropriately covered by meropenem. a nonocclusive thrombus was found in the r popliteal vein-mid r sfv. he was started on heparin gtt. on , a passy-muir valve was placed. a picc was placed on . on , his antibiotics were changed to tigecycline and caspo. pt was consulted. on , an ivc filter was placed. he was then placed on lovenox; heparin gtt was stopped. plastics was consulted and recommended b/l le stsg. on , a ct abd demonstrated decreased size of the l subphrenic fluid collection and no significant new or 3 drained collection. he was transferred to the floor. on , he went to the or with plastics for debridement, scar excision, and meshed skin graft. regular diet was started on ; he tolerated it well. his last jp drain was d/c'd on . he returned to the or with plastics on for removal of bolster. his skin graft was viable. the wound vac was replaced with duoderm gel & xeroform. coumadin was started on . his pca was d/c'd and he was transitioned to po dilaudid with iv dilaudid prn breakthrough pain. antibiotics were d/c'd on as per id recommendations. ot was consulted. on , his cecostomy tube migrated out. ostomy rns were consulted and an appliance was afixed. he was decannulated without respiratory difficulty on . he refused d/c foley throughout his hospital course secondary to difficulty with physical mobility. he also requires a great deal of encouragement to get out of bed to chair, where he sits for >3 hours/day. his pain is controlled on po and iv dilaudid. his picc line is being left in place as per his request for iv dilaudid administration. the risk for line infection has been explained to him, and he requests to keep it nevertheless. medications on admission: meds at home: msir, mscontin, prednisone, clonazepam, percocet, lasix, omeprazole, indocin, lovenox meds on transfer: prednisone 15mg qday, epoetin 40,000u qmwf, lovenox 40mg qday, imipenem 400mg q6h, vanco 500mg , phenergan 12.5mg prn, metoprolol 50mg , zinc sulfate 220mg qday, compazine 10mg , tylenol prn, pregabalin 50mg tid, mscontin 120mg q8h, msir 45mg q3h prn, miconazole powder, hydrocortisone 100mg q8h x 24 hr, protonix 40mg , tpn discharge medications: 1. pregabalin 75 mg capsule sig: two (2) capsule po tid (3 times a day). 2. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). 3. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed. 4. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 5. vitamin a 10,000 unit capsule sig: one (1) capsule po daily (daily). 6. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 7. methadone 40 mg tablet, soluble sig: one (1) tablet, soluble po tid (3 times a day). 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for tachycardia. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. enoxaparin 120 mg/0.8 ml syringe sig: one (1) subcutaneous (2 times a day): d/c once inr is . 12. warfarin 7.5 mg tablet sig: one (1) tablet po once a day: please monitor inr and adjust accordingly. 13. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed. 14. lorazepam 2 mg/ml syringe sig: 0.5-2 mg injection q4h (every 4 hours) as needed for anxiety. 15. hydromorphone 2 mg/ml syringe sig: 0.5 mg injection q3h (every 3 hours) as needed for breakthrough pain. 16. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 200 units heparin per unit qday and prn. 17. insulin sliding scale check fingersticks qac & qhs fingerstick glucose regular insulin dose 0-60 mg/dl amp d50 61-120 mg/dl 0 units 121-140 mg/dl 2 units 141-160 mg/dl 4 units 161-180 mg/dl 6 units 181-200 mg/dl 8 units 201-220 mg/dl 10 units 221-240 mg/dl 12 units 241-260 mg/dl 14 units 261-280 mg/dl 16 units > 280 mg/dl notify m.d. 18. insulin nph human recomb 100 unit/ml suspension sig: five (5) units subcutaneous once a day: give at breakfast. discharge disposition: extended care facility: - discharge diagnosis: -necrotizing soft tissue infection of the chest wall, abdominal wall, right flank and right groin, likely secondary to intraperitoneal abscess, s/p multiple debridements, s/p stsg. -right lower extremity deep venous thrombosis s/p ivc filter. -prolonged intubation requiring tracheostomy. -sepsis. discharge condition: afebrile, vital signs stable, tolerating regular diet, skin grafts viable, in place, foley in place, oobtc x 3 hours/day, pain controlled with po & iv dilaudid. discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please take any new meds as ordered. * continue to ambulate several times per day. * continue to eat several, small meals throughout the day. followup instructions: provider: . phone: date/time: 1:45 provider: , md phone: date/time: 4:15 procedure: venous catheterization, not elsewhere classified interruption of the vena cava enteral infusion of concentrated nutritional substances temporary tracheostomy excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn other repair of abdominal wall other repair of abdominal wall arthrocentesis other laparotomy other laparotomy other laparotomy excision or destruction of lesion or tissue of abdominal wall or umbilicus excision or destruction of lesion or tissue of abdominal wall or umbilicus application of other wound dressing application of other wound dressing angiocardiography of venae cavae diagnoses: anemia, unspecified unspecified septicemia severe sepsis morbid obesity knee joint replacement peritoneal abscess hip joint replacement acute venous embolism and thrombosis of unspecified deep vessels of lower extremity acute appendicitis with peritoneal abscess necrotizing fasciitis 

Answer: The patient is high likely exposed to