This systematic review and network meta-analysis evaluates the efficacy and safety of different carbapenem antibiotics compared to alternative antibiotics for the treatment of complicated urinary tract infections (cUTI). The study included 19 randomized controlled trials (RCTs) involving 7,380 patients. The primary outcomes were clinical and microbiological treatment success, while adverse events (AEs) were assessed as secondary outcomes. Doripenem (DOPM) was found to have lower clinical treatment success rates compared to other carbapenems. Meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) showed higher clinical and microbiological treatment success rates, while imipenem/clastatin (IC) and MV had a higher risk of AEs. MV was recommended as the first-choice treatment for carbapenem-resistant cUTI, while ETPM, BAPM, and meropenem (MEPM) are reasonable choices for empirical therapy. The study highlights the importance of selecting appropriate treatments based on local epidemiology and susceptibility patterns.This systematic review and network meta-analysis evaluates the efficacy and safety of different carbapenem antibiotics compared to alternative antibiotics for the treatment of complicated urinary tract infections (cUTI). The study included 19 randomized controlled trials (RCTs) involving 7,380 patients. The primary outcomes were clinical and microbiological treatment success, while adverse events (AEs) were assessed as secondary outcomes. Doripenem (DOPM) was found to have lower clinical treatment success rates compared to other carbapenems. Meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) showed higher clinical and microbiological treatment success rates, while imipenem/clastatin (IC) and MV had a higher risk of AEs. MV was recommended as the first-choice treatment for carbapenem-resistant cUTI, while ETPM, BAPM, and meropenem (MEPM) are reasonable choices for empirical therapy. The study highlights the importance of selecting appropriate treatments based on local epidemiology and susceptibility patterns.