Molecular Profiles and Antimicrobial Resistance Genes in Bacterial Isolates from Chronic Rhinosinusitis Patients

(1) Background: Chronic rhinosinusitis (CRS) with recurrent symptoms despite therapy raises concern for underlying antimicrobial resistance. While inflammation is central to disease pathophysiology, increasing evidence suggests that resistant bacterial populations within the sinonasal niche may contribute to treatment failure. This study aimed to characterize the molecular resistance profiles of bacterial isolates from refractory CRS patients and evaluate genotype-phenotype concordance and clinical resistance burden. (2) Methods: Our observational study includes 99 bacterial isolates obtained by endoscopically guided nasal swabs from adult CRS patients with recurrent disease. Species identification and antimicrobial susceptibility testing were performed using the VITEK^®2 system. Resistance genes were detected using multiplex-PCR. Statistical analyses included Mann-Whitney U tests for genotype-phenotype associations, Kruskal-Wallis testing across MDR categories, Spearman correlation between gene burden and clinical risk, and concordance metrics. (3) Results: Recognized sinonasal pathogens accounted for 46.5% of isolates, predominantly <i>Staphylococcus aureus</i>, <i>Klebsiella pneumoniae</i>, <i>Proteus mirabilis</i>, and <i>Pseudomonas aeruginosa</i>. β-lactamase genes (<i>tem</i> 25.3%, <i>shv</i> 9.1%, <i>ctxM</i> 8.1%) and macrolide resistance markers (<i>ermB</i> 20.2%) were most prevalent, while carbapenemase genes remained infrequent. Significant phenotype-genotype correlations were observed for <i>mecA</i>-oxacillin, <i>sul1</i>-TMP-SMX, <i>KPC</i>-meropenem, and <i>tem</i>-β-lactams (<i>p</i> < 0.01). Gene burden increased progressively across clinical risk categories (<i>p</i> < 0.001), with MDR/XDR isolates concentrated in patients with repeated antibiotic exposure. Molecular and phenotypic analyses demonstrated high concordance for selected gene-antibiotic pairs, supporting targeted molecular screening as an adjunct to culture-based diagnostics in refractory CRS.