England (12) 18
Pens: Flood 6
Italy (3) 11
Pens: Orquera 2
England face a grand slam and Six Nations championship decider against Wales next week after Toby Flood's six penalties helped scrape past a valiant Italy at Twickenham.
Flood struck four times in the first half, with Luciano Orquera's single penalty all the Italians, who had Edoardo Gori sin-binned, could muster.
Luke McLean scored the only try of the match to put Italy to within three points, but two second half Flood penalties helped England to victory in their tightest-ever win over the Azzuri in 19 meetings.
The victory sets up a title decider against holders Wales at the Millenium Stadium next weekend but serious questions will need to be asked following a performance which had England's players on their knees at the final whistle.
Italy were boosted by the return of captain Sergio Parisse after his ban for insulting a referee while on Stade Francais duty was reduced to 20 days, one of seven changes made by first team manager Luigi Troiani.
The visitors were charged with halting England's assault on both the Six Nations championship and the Grand Slam, while ending a run of 18 successive defeats spanning 22 years of hurt against Stuart Lancaster's men.
Having won their first three championship matches, history suggested England were on course to secure the first half of that elusive double and thus could afford to make five alterations ahead of the decisive encounter against Wales on the final weekend, including a first start for Mako Vunipola at loosehead.
The Saracens front row had the opportunity to justify his selection inside three minutes in the game's first scrum, winning a penalty which allowed the returning Toby Flood, who replaced the injured Owen Farrell, to give England the lead.
The advantage was almost extended during the next phase in play, as Flood's penalty into the corner was kept in by Giovanbattista Venditti, whose clearance kick was charged down by Mike Brown, but the ball went beyond the dead ball line before the Harlequins wing could touch down.
A second Flood penalty in front of the posts capped an impressive England start, but Orquera's successful kick, after a collapsed Italian maul, halved the deficit and provided a stark reminder of the potential punishment of further indiscipline.
Alessandro Zanni and Flood both went close to notching the first try of the afternoon, but England's job got slightly easier when Edoardo Gori was sin-binned for pulling back Alex Goode after the half-back's kick was charged down.
But the hosts were unable to take advantage, Chris Ashton displaying further signs of his problematic form with a woeful forward pass after being set clear by Manu Tuilagi.
Two further Flood penalties did extend England's lead before the break but after conceding nine penalties in the opening 40 minutes, Italy could be forgiven for considering themselves fortunate to still be in touch.
Restored to a full compliment after Gori's reintroduction, Italy gave away another penalty allowing Flood, the Leicester Tigers fly half, to increase the home side's lead to 12.
Orquera capitalised on England indiscipline to reduce the arrears, and after Care's horribly sliced box-kick, the Treviso 10 countered with a beautiful kick into the corner to find the onrushing McLean who went over in the corner.
Tom Croft was introduced for his first cap since suffering a serious neck injury suffered last April, replacing James Haskell and control was exerted in the form of another Flood penalty, which took him to third in the list for all-time test points scorers for England.
England had to weather a barrage of Italian pressure in the closing ten minutes, but when Courtney Lawes held a line-out on Italy's throw it helped clinch a fourth win in a row ahead of next weekend's trip to Cardiff.
England: A Goode; C Ashton; M Tuilagi B Barritt; M Brown; T Flood; D Care; M Vunipola; T Youngs; D Cole; J Launchbury; G Parling; J Haskell; C Robshaw; T Wood
Replacements: D Hartley (for T Youngs); D Wilson (for D Cole); J Marler (for M Vunipola); C Lawes (for G Parling); T Croft (for J Haskell); B Youngs (for D Care); F Burns; B Twelvetrees (for B Barritt)
Italy: A Masi; G Venditti, G Canale, G Garcia, L McLean; L Orquera, E Gori; A De Marchi, L Ghiraldini, M Castrogiovanni, Q Geldenhuys, J Furno, A Zanni, R Barbieri, S Parisse
Replacements: D Giazzon (for L Ghiraldini), A Lo Cicero (for A de Marchi), L Cittadini (for M Castrogiovanni), A Pavanello (for Q Geldenhuys), F Minto (for R Barbieri), S Favaro (for J Furno), T Botes (for E Gori), T Benvenuti (for L McLean)