Objective To evaluate the clinical characteristics and risk factors of healthcare-associated urinary tract infection (HA-UTI) due to vancomycin-resistant Enterococcus (VRE), and provide basis for clinical prevention and control. Methods Patients with VRE HA-UTI in a tertiary first-class hospital in Guangdong Province from January 2021 to October 2023 were selected as the VRE group. A 1 ∶2 case-control study method was conducted to select patients with vancomycin-sensitive Enterococcus (VSE) UTI as the VSE group. Clinical characteristics of two groups of patients were compared and analyzed. Risk factors for VRE HA-UTI were analyzed using univariate regression and logistic multivariate regression. Results A total of 32 patients in the VRE group and 64 patients in the VSE group were included in the analysis. In VRE group, most patients were female (68.75%), aged ≥60 years (71.88%), and from intensive care unit (ICU, 56.25%). The main detected pathogen was vancomycin-resistant Enterococcus faecium (VREfm, 96.87%). The proportion of clinical symptoms such as fever and lumbago as well as the levels of procalcitonin (PCT) and C-reactive protein (CRP) in patients in the VRE group were all higher than those in the VSE group (all P<0.05). Logistic regression analysis results showed that concomitant pulmonary infection (OR=6.890, 95%CI: 1.098-43.218, P=0.039), history of hypertension (OR=4.240, 95%CI: 1.084-16.581, P=0.038), and cephalosporin antibiotic exposure before infection (OR=4.642, 95%CI: 1.270-16.967, P=0.020) were independent risk factors for VRE HA-UTI. There were 32 and 64 strains of Enterococcus detected from VRE group and VSE group, respectively. VRE had higher resistance rates to ciprofloxacin, amoxicillin, ampicillin, penicillin G, tetracycline, high concentration gentamicin, and levofloxacin than VSE (all P<0.05). Conclusion Patients with VRE HA-UTI often have multiple underlying diseases and poor nutritional status, and are highly resis-tant to multiple antimicrobial agents. Clinical attention should be focused on patients with concomitant pulmonary infection, history of hypertension, and exposure to cephalosporin antibiotics.