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We recently reported the fungal “mycobiome” and its association with outcomes in a longitudinal prospective cohort study of 100 patients with diabetic foot ulcers (1). We appreciate the letter to the editor by Malone and Dickson (2) and are pleased that our findings generated interest and discussion among basic scientists and clinicians.The technique used to collect a sample for microbiome analysis is of great importance. All downstream processing and analysis relies on an accurate and reliable sample. Malone and Dickson are correct in that other groups advocate using more-invasive methods, though rigorous, peer-reviewed evidence to suggest the superiority of those invasive techniques is lacking in the literature. Interestingly, we noted that Malone authored a paper, “Deep Wound Cultures Correlate Well with Bone Biopsy Culture in Diabetic Foot Osteomyelitis” (3), in which the results seemingly contradict the argument presented in the letter. Nonetheless, we are most appreciative for the opportunity to further expand on our reasons for employing the Levine technique for collecting swab specimens.Levine’s technique is different than other swab techniques in that it samples fluid from deep tissue layers, similarly to aspiration of wound fluid. …

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