Background: Hematopoietic stem cell transplantation (HSCT) can significantly disrupt gut microbiota, increasing susceptibility to Enterococcus infections. These infections pose a high mortality risk, with rates between 18% on day 7 and 31% by day 30 post-transplant. This study investigates the mortality in HSCT recipients admitted for Enterococcus bloodstream infections (EBSI). Methods: We conducted a cross-sectional study utilizing the 2018-2021 National Inpatient Sample database, focusing on adult HSCT recipients (≥18 years) primarily hospitalized for EBSI (n=471). Our analysis included descriptive statistics, propensity score matching (based on age, gender, race, and comorbidities), and multivariate regression to adjust for confounding variables. The results were expressed as adjusted Odds Ratios (aOR) with significance at p≤0.05. Results: Among 198,045 transplant patients, 20.4% (n=40,462) had undergone HSCT, with 1.3% (n=531) being admitted due to EBSI. Among HSCT recipients, EBSI was seen in 1.4% of HSCT-Leukemia cohort and 2.4% of HSCT-AML cohort. In all HSCT recipients, the Enterococcus cohort had 38.98% of patients with urinary tract infection and 0.56% had peritoneal abscesses. In HSCT recipients with EBSI, patients with pancytopenia revealed higher mortality than survival (63.64% vs 44.33%, p<0.01). Crude analysis suggested higher all-cause mortality in the Enterococcus cohort compared to non-Enterococcus cohort (10.4% vs 4.6%, p<0.001). However, after adjusting for confounders, the mortality risk in the Enterococcus cohort was found to be lower (aOR 0.09, 95% CI 0.03-0.3, p<0.001). Key factors associated with increased mortality (p≤0.05) included the need for invasive ventilation (aOR=9.7), acute respiratory failure (aOR=4.3), fungal infections (aOR=4.2), severe sepsis (aOR=3.0), and acidosis (aOR=2.9). Additionally, palliative care was needed more in the Enterococcus cohort compared to the non-Enterococcus cohort (11.1% vs. 6.9%, p<0.001). Conclusion: Enterococcus infections in HSCT recipients have a high mortality rate, but their mortality risk is low. This indicates that Enterococcus infection is a sign of clinical deterioration but is not a direct cause of mortality. When encountering patients with signs of bone marrow failure and severe sepsis, along with symptoms of respiratory failure and urinary tract infection, aggressive treatment and multidisciplinary care are required, as Enterococcus infection is a marker of poor prognosis. Keywords: Hematopoietic stem cell transplant, Enterococcus infection, Mortality, Sepsis, HSCT, Transplant