A randomized controlled trial in a syringe exchange programme showed no evidence that a strength-based case management intervention improved attendance for treatment over referral alone. Attendance rates were high in both groups.

The susceptibility pattern of Mycobacterium marinum was determined. Quinupristin-dalfopristin and telithromycin were less active than clarithromycin. Linezolid showed good antimicrobial activity at clinically achievable concentrations. Gatifloxacin, levofloxacin, and moxifloxacin displayed activities similar to those of ciprofloxacin. Gemifloxacin was less active. The Etest method showed variable agreement with the reference method.Mycobacterium marinum was recognized as a human pathogen in 1959 (13). Infection occurs when traumatized skin is exposed to contaminated water and is usually localized to the skin of the upper extremity. The organism can also cause deep-tissue infection and, rarely, disseminated disease (4, 5, 6). The incubation period has been estimated to between 2 and 4 weeks, and the infection usually resolves spontaneously after 6 to 30 months. Since infection with M. marinum is quite rare and the organism is resistant to many conventional antimicrobial agents, optimal treatment has yet to be established. The aim of this study was to determine the susceptibility of M. marinum to new antimicrobial agents. Furthermore, the Etest method was evaluated.Of the strains tested, 43 were clinical isolates collected in Sweden from 1989 to 2001. M. marinum ATCC 2275 was also included as a reference strain. Ciprofloxacin and moxifloxacin were from Bayer, Wuppertal, Germany; clarithromycin was from Abbott, Queenborough, United Kingdom; erythromycin was from Astra, Södertälje, Sweden; gatifloxacin was from Grünenthal, Stolberg, Germany; gemifloxacin was from SmithKline Beecham, Munich, Germany; linezolid was from Pharmacia & Upjohn, Kalamazoo, Mich.; and levofloxacin, quinupristin-dalfopristin, and telithromycin were from Aventis Pharma, Vitry sur Seine, France.The MICs of the drugs were determined by using MuellerHinton agar supplemented with 5% OADC (oleic acid, albumin, dextrose, and catalase) (1). A multipoint inoculator was used to deliver approximately 10 4 to 10 5 CFU per spot to agar dilution plates containing antimicrobial agents in twofold dilutions. All the plates were incubated at 30°C for 7 days. The MICs for the M. marinum strains were defined as the lowest concentration allowing no visible growth at the spot of inoculation on the agar dilution plates. The MICs for Staphylococcus aureus ATCC 21212 and Enterococcus faecalis ATCC 21213 were determined after 24 h and shown to be within reference values for all antibiotics. Etest strips were obtained from Biodisk (Solna, Sweden). The correlation of the results determined by the Etest method and the agar dilution method, used as a reference, was determined on the basis of the agreement, which was defined as the percentage of clinical isolates for which the MIC was the same within Ϯ1 log 2 dilution.The MICs of 10 antimicrobial agents determined by the agar dilution method are presented in Table 1. The MICs of clarithromycin (MIC at which 50% of the isolates tested were inhibited [MIC 50 ], 1 g/ml; MIC 90 , 1 g/ml) were lower than those for erythromycin...

BackgroundHeroin dependence is associated with high mortality. Opioid agonist treatment (OAT) with methadone or buprenorphine has strong evidence for treatment of this relapsing condition. In our setting, OAT has been associated with strict and demanding intake procedures, often with requirements of social stability, but also high, approximately 80 percent 12-month retention rates. In a recent randomized controlled trial, we demonstrated high rates of successful rapid referral from a syringe exchange programme (SEP) to treatment with methadone or buprenorphine, including actual treatment initiation. The objectives of this study were to assess 12-month retention rates, in order to assess whether a novel referral program of current drug users at a SEP would achieve retention rates comparable to more traditional intake procedures.MethodsThe present report is a 12-month follow-up of 71 patients who successfully started treatment with methadone or buprenorphine/naloxone. Patient data from baseline and at 12 months were collected.ResultsOut of the 71 patients who started treatment, 58 (82%) were still in treatment after 12 months.ConclusionThis was a population, referred from a SEP, with a high drug use severity on admission and no pretreatment requirement for social stability, but there were still high retention rates at 12 months comparable to regular opioid agonist clinics in our setting.

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