Which approach is most appropriate initially to identify the source of a postoperative fever?

• A. Evaluate with exam, cultures, and imaging as indicated to determine source
• B. Start broad-spectrum IV antibiotics immediately
• C. Obtain only a chest radiograph
• D. Observe and recheck in 24 hours

Answer: (A)

When a patient develops a fever after surgery, the priority is to locate the source with a systematic assessment rather than jumping straight to treatment. The best initial approach is a careful physical examination complemented by obtaining cultures and imaging as indicated. This allows you to identify potential sources such as a wound infection, urinary tract infection, pneumonia, line or catheter infection, intra-abdominal abscess, or an anastomotic leak, and to tailor therapy accordingly.

If the patient is unstable or showing signs of sepsis, you would initiate broad-spectrum antibiotics after obtaining cultures, but in a stable patient the first step is to search for the source with exam, cultures, and targeted imaging rather than starting antibiotics or limiting evaluation to one organ system. Limiting assessment to a single test, like a chest radiograph, or delaying evaluation by watching for 24 hours, risks missing the source and delaying appropriate management.