Vancomycin-resistant Enterococcus faecalis was isolated from a foot infection of a 40-year-old man. The patient had a chronic diabetes-related foot ulcer and underwent amputation of a gangrenous toe. He subsequently developed methicillin-resistant Staphylococcus aureus bacteremia. The infection was treated with vancomycin. One week later, he developed a vancomycin-resistant S. aureus (VRSA) infection. This is the first case of VRSA in the United States. What is the most likely source of the VRSA?
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