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Despite starting brightly the Azzurri struggled to break down their opponents for long spells and were given a scare when Romania took a 12-8 lead in the second half.
But the Romanians' indiscipline cost them dearly in the final half-hour as a series of penalties from Ramiro Pez proved the difference between the sides.
Coach Pierre Berbizier made six changes to the side trounced 76-14 by New Zealand last week and it did not take long for his team to get off the mark.
Pez capitalised on a loose ball from the Romanian scrum to find Santiago Dellape, who fell awkwardly as he went over.
David Bortolussi matched an earlier Iulian Dumitras kicking effort by going short with the conversion but he soon made amends with his second kick, firing straight between the posts to put them 8-0 ahead.
Twice Italy came close to adding to their lead but on both occasions they were denied by referee Tony Spreadbury.
Catalin Fercu's blushes were spared after he was tap-tackled when attempting to counter from his own area but the try was disallowed for a penalty earlier in the move.
And just three minutes later video evidence indicated Carlo Festuccia had taken the ball out of touch before touching down.
Italy's day got even worse moments into the second half when Alexandru Manta, among a crowd of bodies, was adjudged to have touched down by the video referee despite the ball appearing to drop out of his hand.
Dumitras failed to convert but they took the lead a minute later when Marius Tincu drove through for a try.
A lengthy delay ensued as Italy scrum-half Paul Griffen was carried off the field but newly-appointed kicker Ionut Dimofte held his nerve to put Romania 12-8 ahead.
The Italians found themselves back in the lead when Spreadbury awarded them a penalty try for persistent fouling and Pez kicked the conversion to put them 15-12 up with 20 minutes remaining.
Like Dimofte, Pez looked more assured than his predecessor, and twice kicked penalties to put his side 21-12 ahead.
Diomofte cut the deficit to six points with another penalty but further ill discipline from Romania skipper Sorin Socol undid the good work as Pez restored the advantage.
Italy were guilty of the same offence just moments later and again Dimofte kept up his impressive kicking record but the Azzurri were able to hold on for a hard-fought win.
Italy: (8) 24
Tries: Dellape, penalty
Con: Pez
Pens: Bortolussi, Pez 3
Romania: (0) 18
Tries: Manta, Tincu
Con: Dimofte
Pens: Dimofte 2
Italy: Bortolussi, Robertson, Canale, M. Bergamasco, Masi, Pez, Griffen, Lo Cicero, Festuccia, Castrogiovanni, Dellape, Bortolami, Sole, M. Bergamasco, Parisse.
Replacements: Ghiraldini, Aguero, Bernabo, Vosawai, Troncon, Galon, de Marigny.
Romania: Dumitras, Fercu, Gal, Gontineac, Brezoianu, Dimofte, Sirbu, Toderasc, Tincu, B. Balan, Socol, Petre, Corodeanu, Manta, Tonita.
Replacements: Mavrodin, Popescu, Ratiu, Tudori, Calafeteanu, Tofan, Vlad.
Referee: T Spreadbury (England)
