The emergence of bloodstream infections (BSI) caused by vancomycin-resistant Enterococci (VRE) has caused concern.Nonetheless, it remains unclear whether these types are associated with an excess risk of severe outcomes whencompared with infections caused by vancomycin-susceptible Enterococci (VSE). This cohort study includedhospitalized patients in Denmark with Enterococcus faecium-positive blood cultures collected between 2010 and 2019identified in the Danish Microbiology Database. We estimated 30-day hazard ratio (HR) of death or discharge amongVRE compared to VSE patients adjusted for age, sex, and comorbidity. The cohort included 6071 patients withE. faecium BSI (335 VRE, 5736 VSE) among whom VRE increased (2010–13, 2.6%; 2014–16, 6.3%; 2017–19; 9.4%).Mortality (HR 1.08, 95%CI 0.90–1.29; 126 VRE, 37.6%; 2223 VSE, 37.0%) or discharge (HR 0.89, 95%CI 0.75–1.06; 126VRE, 37.6%; 2386 VSE, 41.6%) was not different between VRE and VSE except in 2014 (HR 1.87, 95% CI 1.18–2.96).There was no interaction between time from admission to BSI (1–2, 3–14, and >14 days) and HR of death (P = 0.14) ordischarge (P = 0.45) after VRE compared to VSE, despite longer time for VRE patients (17 vs. 10 days for VSE, P <0.0001). In conclusion, VRE BSI was not associated with excess morbidity and mortality. The excess mortality in 2014only may be attributed to improved diagnostic- and patient-management practices after 2014, reducing time toappropriate antibiotic therapy. The high level of mortality after E. faecium BSI warrants further study.