Culture without culturing: Exploring alignments between practices and expectations towards culture-independent methods of sepsis diagnostics in a Dutch intensive care unit

Blood culturing is the standard laboratory practice for identifying bloodstream pathogens in sepsis care but it has long time-to-results. Therefore, culture-independent methods (CIM) have been developed to reduce diagnostic delays, yet they are hardly used in routine clinical practice. We examine how current practices of bacterial identification in the context of sepsis care are enabled through the alignment of actors between an intensive care unit (ICU) and a bacteriological laboratory, and explore the alignment of expectations towards CIM. The empirical findings are based on ethnographic research in a Dutch university medical centre, including observations and interviews with participants involved in current sepsis care, as well as diagnostic developers. We observed established collaboration between an ICU and a bacteriological laboratory whereby each actor has clear responsibilities and tacit expertise. For CIM of sepsis diagnostics, expectations are not yet aligned, which postpones the realisation of new diagnostics and stabilizes the existing workflow. Successful implementation of CIM may require developers to not only rethink the material capacities of new technologies but also its end-users and places for implementation. The article adds to literature on alignment and sociology of expectations by exploring alignment at the level of material resources, social networks, as well as expectations.