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You can get by with no Italian, but it definitely helps.
For the first couple days my wife was commenting how she thought people were rude in the hotel or restaurants. I told her that it might have something to do with the fact that she spoke English as though she expected it to be their language, too. She finally got over herself started trying to use a few basic words and phrases and was amazed at how much it changed her interactions with people.
It's the polite thing to try to do anywhere but ultimately unnecessary to get by. I've traveled to something like 25 countries now and learn 4 phrases before I go: hello, thank you, do you speak English, where's the bathroom. And that's more than you need in any kind of tourist areas. Shoot, the public transport is easier to navigate than NYC in Rome by far.
Only time I've felt a little out of it because of the language barrier was rural Tanzania, and my dad speaks Swahili fluently so I was fine.