A systematic review and network meta-analysis compared the efficacy and safety of carbapenems with alternative antibiotics for treating complicated urinary tract infections (cUTI). The study included 19 randomized controlled trials (RCTs) involving 7380 patients. Results showed that meropenem/vaborbactam (MV) had higher clinical and microbiological treatment success rates compared to other carbapenems, while imipenem/cilastatin (IC) and MV had higher risks of adverse events (AEs). Ertapenem (ETPM), biapenem (BAPM), and meropenem (MEPM) also showed good treatment success rates with lower AE risks. Doripenem (DOPM) had lower clinical treatment success. The study suggests MV as a first-choice treatment for carbapenem-resistant cUTI, with ETPM, BAPM, and MEPM as alternative options. The findings highlight the importance of considering both efficacy and safety when selecting antibiotics for cUTI. The study also noted limitations, including moderate quality of RCTs and potential biases from missing data. Overall, the results support the use of MV and other carbapenems for cUTI, but further high-quality research is needed to confirm these findings.A systematic review and network meta-analysis compared the efficacy and safety of carbapenems with alternative antibiotics for treating complicated urinary tract infections (cUTI). The study included 19 randomized controlled trials (RCTs) involving 7380 patients. Results showed that meropenem/vaborbactam (MV) had higher clinical and microbiological treatment success rates compared to other carbapenems, while imipenem/cilastatin (IC) and MV had higher risks of adverse events (AEs). Ertapenem (ETPM), biapenem (BAPM), and meropenem (MEPM) also showed good treatment success rates with lower AE risks. Doripenem (DOPM) had lower clinical treatment success. The study suggests MV as a first-choice treatment for carbapenem-resistant cUTI, with ETPM, BAPM, and MEPM as alternative options. The findings highlight the importance of considering both efficacy and safety when selecting antibiotics for cUTI. The study also noted limitations, including moderate quality of RCTs and potential biases from missing data. Overall, the results support the use of MV and other carbapenems for cUTI, but further high-quality research is needed to confirm these findings.