ROME – A missed penalty by Jorginho in the 89th minute means Italy will have to earn their place at the 2022 World Cup in their final qualifying match in Northern Ireland on Monday.
Silvan Widmer grabbed the opener for Switzerland before Giovanni Di Lorenzo's header saw the shares spoiled at the Olimpico.
Nicolo Barella played 69 minutes before being replaced by Bryan Cristante.
The two teams now go into the final round of games level on 15 points. Italy have a better goal difference so need to match or better Switzerland's result. The Azzurri travel to Belfast while the Swiss host Bulgaria.
Should the pair end up with the same goal difference, Switzerland will take the automatic spot by virtue of their goal scored at the Olimpico.
GROUP C STANDINGS
Italy 15 (+11)
Switzerland 15 (+9)
Northern Ireland 8