Bed bug outbreaks are surging across the United States, driven by widespread pesticide resistance and increased travel. Chicago has topped the national list of most-infested cities for consecutive years, with Los Angeles, Detroit, Cleveland, and Indianapolis rounding out the top five. If you’re dealing with an outbreak or trying to avoid one, here’s what you need to know about why these insects are so hard to eliminate, how to spot them early, and what actually works to get rid of them.
Why Bed Bugs Keep Coming Back
Bed bugs were nearly eradicated in the U.S. by the mid-20th century, largely thanks to DDT. But the same evolutionary pressure that made DDT effective also planted the seeds for today’s resurgence. The most commonly used insecticides now belong to a chemical family called pyrethroids, synthetic versions of a natural compound found in chrysanthemum plants. Both DDT and pyrethroids kill insects by targeting the same structures in their nerve cells. That means the genetic mutations bed bugs developed to survive DDT also protect them from pyrethroids.
The scale of this resistance is staggering. Changing just two of the 2,000 amino acids in a single protein on a bed bug’s nerve cells can make it 250 times more resistant to a common pyrethroid. Most sprays sitting on store shelves still rely on pyrethroids, which is why so many do-it-yourself treatments fail completely. Some bed bug populations have even evolved resistance to neonicotinoids, the next generation of chemicals that were supposed to fill the gap.
Global travel is the other major driver. Bed bugs are hitchhikers. They climb into luggage, clothing, and furniture, then ride along to new locations. Vacation destinations are increasingly showing up in outbreak rankings. Tampa and Myrtle Beach both entered the national top 50 this year, reinforcing the link between tourist traffic and infestations.
Where Outbreaks Are Worst Right Now
Orkin’s 2026 rankings, based on treatment data from residential and commercial properties, paint a clear geographic picture. The Midwest dominates. Ohio alone has six cities in the top 50, and the full top ten list reads: Chicago, Los Angeles, Detroit, Cleveland, Indianapolis, Springfield (Illinois), Washington D.C., Columbus, Pittsburgh, and Grand Rapids. Nashville and Oklahoma City each jumped 10 spots, suggesting rapidly growing problems in those metro areas.
Dense housing, older building stock, and high population turnover all contribute to why certain cities consistently rank high. Bed bugs spread easily through shared walls, hallways, and laundry facilities in apartment buildings, which is why urban centers see disproportionate infestations.
How to Spot an Infestation Early
Bed bugs are nocturnal and small enough to hide in a mattress seam, so most people don’t see the bugs themselves first. Instead, you’ll notice the evidence they leave behind. The most reliable sign is fecal spotting: small black dots, often clustered in groups of ten or more, found along mattress seams, on box spring frames, behind headboards, or near baseboards. These spots are black rather than red because the blood has already been digested, and they feel smooth to the touch because they dry from a liquid state.
Shed skins are another telltale sign. Bed bugs molt five times before reaching adulthood, leaving behind translucent, empty shells that look like a hollow version of the bug itself. You’ll find these in the same hiding spots: mattress seams, behind headboards, along baseboards, and in ceiling-wall junctions. When an infestation is established, you may find full aggregation sites containing live bugs at multiple life stages, shed skins, fecal spots, and tiny white eggs all clustered together. Check inside screw holes in furniture, where box spring fabric is stapled to the frame, behind loose wallpaper, inside curtain rods, and even in books and picture frames.
What Bed Bug Bites Look and Feel Like
Bed bugs inject a numbing agent and a blood thinner when they bite, so you typically won’t feel anything in the moment. Bite marks usually appear one to two days later as small, raised bumps that resemble pimples or a mild rash. They tend to itch, sometimes with a burning sensation, and appear on skin that contacts the bed: arms, legs, and back are the most common areas.
Not everyone reacts the same way. Some people develop noticeable welts, while others show no visible marks at all, which can delay detection of an infestation by weeks. The main risk from bites is secondary skin infection caused by scratching. In rare cases, people experience a severe allergic reaction with symptoms like difficulty breathing, a swollen tongue, or blisters, which requires emergency care.
What Actually Kills Bed Bugs
Heat is the most reliable weapon against bed bugs because they cannot evolve resistance to temperature the way they can to chemicals. Bed bugs die after 90 minutes of constant exposure to 113°F, or within 20 minutes at 118°F. Eggs are tougher and require 118°F for a full 90 minutes to reach complete mortality. Professional whole-room heat treatments raise the temperature of an entire space above 120°F and hold it there for at least 60 minutes after every sensor in the room hits the lethal threshold.
For individual items, a household dryer set on high will kill all life stages, including eggs, in 30 minutes. The items need to be loosely filled so heat circulates freely. Washing alone is less effective; it’s the sustained heat of the dryer that does the killing.
On the chemical side, a newer class of insecticide has shown strong results against resistant populations. Researchers funded by the USDA found that formulations using a compound called isocycloseram killed 100% of bed bugs within three to four days, whether sprayed directly or applied as a surface residue. Even at one-quarter strength, every bug that crawled across a fresh treated surface was dead within five days. The most impressive finding: 30-day-old residue still achieved 100% kill rates, while competing pyrethroid-based products dropped to as low as zero percent effectiveness over the same period. This represents a genuine shift in chemical options after years of diminishing returns from existing sprays.
Who Pays for Treatment
Responsibility for bed bug treatment varies by location, but the trend in housing law is toward placing the burden on property owners. New York City provides one of the clearest legal frameworks: bed bugs are classified as a Class B (hazardous) violation, and landlords are legally required to eradicate infestations within 30 days. Building owners must also provide tenants with a written disclosure of any bed bug history in the building over the past year.
Many other cities and states have adopted similar rules requiring landlords to cover extermination costs, though the specifics differ. If you’re renting, check your local housing code. In most jurisdictions, a landlord cannot simply ignore a reported infestation or pass the cost to the tenant without legal basis.
Preventing Bed Bugs While Traveling
Hotels, motels, and short-term rentals are the most common places people unknowingly pick up bed bugs. Before settling into a room, pull back the sheets and inspect the mattress seams, headboard, and nearby furniture for fecal spots or shed skins. If you find evidence, request a different room that doesn’t share a wall with the one you left.
Keep luggage off the bed and floor. Use the metal luggage rack if one is available, and consider sealing your belongings in plastic bags, especially if you have any suspicion of bugs in the room. When you get home, unpack in a hard-surfaced, well-lit area like a garage or laundry room rather than the bedroom. Run all clothing through the dryer on medium or high heat for at least 30 minutes before putting anything away. Items that can’t be laundered can go directly into the dryer at the same setting. For dry-clean-only clothes, seal them in a plastic bag and let your dry cleaner know about the potential exposure.
Finally, inspect the suitcase itself. Use a flashlight to check seams, folds, and pockets for bugs or eggs, then scrub those areas with hot soapy water. A household steamer can also be used to heat-treat luggage before storing it.