OBJECTIVES: Carbapenems have been commonly used to treat for bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamase (ESBL), but usage of the antibiotics is controversial as concerns of increasing rates of carbapenem resistance in the bacteria. This study systematically reviewed the recently published evidence to compare mortality associated with carbapenems and alternative antibiotics for treatment of ESBL-positive bacteremia in empirical therapy. METHODS: Comprehensive literature search was performed until April, 2015 using three international databases and seven domestic databases without restriction of language and date. Studies reporting mortalities in both groups, which used carbapenems or alternatives, were eligible on our inclusion criteria. β-lactam/β-lactamase inhibitor combinations (BL/BLIs), fluoroquinolones, cephalosporins, and aminoglycosides were considered as the alternatives of the carbapenems. Meta-analysis of this study was performed by RevMan Version 5.3 and random effect model was always applied for all variables regardless of IRESULTS: A total of 19 studies with 2,134 patients were finally selected for this study and there were no randomized controlled trials. In comparison with the all types of alternative antibiotics categorized in BL/BLIs, fluoroquinolones, cephalosporins, aminoglycosides, non-BL/BLIs, and non-carbapenems, the patients’ group treated with carbapenems never showed superior results in overall mortalities (BL/BLIs OR 0.60, 95% CI 0.28-1.29; fluoroquinolones OR 0.71, 95% CI 0.37-1.36; cephalosporins OR 0.38, 95% CI 0.22-0.65; aminoglycosides OR 0.54, 95% CI 0.18-1.63; non-BL/BLIs OR 0.65, 95% CI 0.43-0.99; non-carbapenems OR 0.70, 95% CI 0.48-1.04). Likewise, in subgroup analyses based on study design or appropriateness of antibiotics used, there were no statistically significant differences in the mortality between the carbapenems and the all types of comparisons. CONCLUSIONS: Although these results were based on only observational studies, alternatives of carbapenems, which are BL/BLIs and et al., might be considered one of the treatment options for empirical therapy of patients with ESBL-positive Enterobacteriaceae bacteremia.