Diego Godin struck with just nine minutes remaining to claim a second-place finish in Group D for the South Americans.
The Italians started brightly, and they nearly found the net on 12 minutes as Andrea Pirlo's free kick was pushed away by Fernando Muslera.
Despite Italy's control of an opening half of few chances, Uruguay almost took the lead against the run of play on 33 minutes when Luis Suarez saw his shot on the angle kept out by the evergreen Gianluigi Buffon.
Italy tried to unlock the Uruguayan defence after that scare, but the South Americans held firm to go in goalless at the break.
Uruguay showed more attacking intent after half time with Cristian Rodriguez firing wide before Italy were reduced to 10 men when Claudio Marchisio was shown a straight red card following a high challenge on Arevalo Rios on the hour.
Suarez forced another save from Buffon soon after, but Italy showed plenty of organisation for the remainder of the match despite the dismissal of Marchisio.
A controversial moment came with just over 10 minutes to play as Suarez appeared to bite Giorgio Chiellini, though the forward was not punished for the incident.
Instead, Uruguay scored the decisive goal with just nine minutes left when Diego Godin converted from a corner.
Italy pushed hard for the equaliser that would have sent them through to the second round, but they were unable to find it as Uruguay sealed their place in the last 16.
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